Provider Demographics
NPI:1598106213
Name:HAKIM, MINA H (MD)
Entity Type:Individual
Prefix:
First Name:MINA
Middle Name:H
Last Name:HAKIM
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 1:3661 TORRANCE BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4812
Mailing Address - Country:US
Mailing Address - Phone:310-953-0020
Mailing Address - Fax:
Practice Address - Street 1:3661 TORRANCE BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4812
Practice Address - Country:US
Practice Address - Phone:310-953-0020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-10
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN18757208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics