Provider Demographics
NPI:1619979606
Name:HAKIMIAN MD A PROFESSIONAL CORP, NAVID
Entity Type:Individual
Prefix:
First Name:NAVID
Middle Name:
Last Name:HAKIMIAN MD A PROFESSIONAL CORP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 91765
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90009-1765
Mailing Address - Country:US
Mailing Address - Phone:310-645-3029
Mailing Address - Fax:310-645-8685
Practice Address - Street 1:8540 S SEPULVEDA BLVD
Practice Address - Street 2:SUITE 1111
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3807
Practice Address - Country:US
Practice Address - Phone:310-645-3029
Practice Address - Fax:310-645-8685
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2008-06-23
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-10
Provider Licenses
StateLicense IDTaxonomies
CAG70719207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G707191Medicaid
CAF10377Medicare UPIN