Provider Demographics
NPI:1619594835
Name:HAKIMIYAN, RIZINA (DMD)
Entity Type:Individual
Prefix:
First Name:RIZINA
Middle Name:
Last Name:HAKIMIYAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 S CLARK ST APT 1006
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-1745
Mailing Address - Country:US
Mailing Address - Phone:847-414-8781
Mailing Address - Fax:
Practice Address - Street 1:4849 N MILWAUKEE AVE STE 403
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2169
Practice Address - Country:US
Practice Address - Phone:630-366-2370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-03
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.032651122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist