Provider Demographics
NPI:1255465472
Name:HAKEEM, KHANJO
Entity Type:Individual
Prefix:MR
First Name:KHANJO
Middle Name:
Last Name:HAKEEM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N GAND AVENUE
Mailing Address - Street 2:#213
Mailing Address - City:W.COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791
Mailing Address - Country:US
Mailing Address - Phone:626-831-6704
Mailing Address - Fax:
Practice Address - Street 1:851 N OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-4343
Practice Address - Country:US
Practice Address - Phone:626-831-6704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health