Provider Demographics
NPI:1639363260
Name:HAKIMI, AHMAD NABIL (MD, FACS)
Entity Type:Individual
Prefix:
First Name:AHMAD
Middle Name:NABIL
Last Name:HAKIMI
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:557 W MORTON AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3383
Mailing Address - Country:US
Mailing Address - Phone:559-781-9922
Mailing Address - Fax:559-781-9925
Practice Address - Street 1:557 W MORTON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3383
Practice Address - Country:US
Practice Address - Phone:559-781-9922
Practice Address - Fax:559-781-9925
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95840208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1326360637Medicaid
CA1639363260Medicaid
CA1639363260Medicaid
CADH992ZMedicare PIN
CA1639363260Medicare PIN
CADH978AMedicare PIN