Provider Demographics
NPI:1609333459
Name:HAKIM, MUNA SIRAJ (DDS)
Entity Type:Individual
Prefix:
First Name:MUNA
Middle Name:SIRAJ
Last Name:HAKIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 S INDIANA AVE APT 6212
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3115
Mailing Address - Country:US
Mailing Address - Phone:609-598-3369
Mailing Address - Fax:
Practice Address - Street 1:45 S PARK BLVD STE 105
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-6299
Practice Address - Country:US
Practice Address - Phone:630-756-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-28
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190335201223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry