Provider Demographics
NPI:1255493136
Name:WAKIM, EMILE P (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILE
Middle Name:P
Last Name:WAKIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18800 DELAWARE ST. STE 1100
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648
Mailing Address - Country:US
Mailing Address - Phone:714-841-5333
Mailing Address - Fax:714-841-5303
Practice Address - Street 1:18800 DELAWARE ST. STE 1100
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648
Practice Address - Country:US
Practice Address - Phone:714-841-5333
Practice Address - Fax:714-841-5303
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94520174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0004039Medicaid
CAWA94520AMedicare UPIN
CAWA94520CMedicare PIN
CA0004039Medicaid
CAWA94520AMedicare PIN