Provider Demographics
NPI:1437168325
Name:HAKKI, FARIS (MD)
Entity Type:Individual
Prefix:
First Name:FARIS
Middle Name:
Last Name:HAKKI
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 1:4618 FOXHALL CRES NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-1061
Mailing Address - Country:US
Mailing Address - Phone:202-744-6314
Mailing Address - Fax:
Practice Address - Street 1:106 IRVING ST NW
Practice Address - Street 2:POB 408
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2927
Practice Address - Country:US
Practice Address - Phone:202-877-5007
Practice Address - Fax:202-877-0090
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD212912086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC521958465OtherTAX ID FOR HAKKI MEDICAL ASSOCIATION
DC026637100Medicaid
DC796207OtherSOLO PRACTICE PTAN 792607
DC796207OtherSOLO PRACTICE PTAN 792607