Provider Demographics
NPI: | 1639515752 |
---|---|
Name: | HAKIM DENTAL GROUP |
Entity Type: | Organization |
Organization Name: | HAKIM DENTAL GROUP |
Other - Org Name: | SMILES |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | DENTIST |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MAHSA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HAKIM |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DDS |
Authorized Official - Phone: | 415-693-9139 |
Mailing Address - Street 1: | 450 SUTTER ST RM 1326 |
Mailing Address - Street 2: | |
Mailing Address - City: | SAN FRANCISCO |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 94108-4007 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 415-693-9139 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 450 SUTTER ST RM 1326 |
Practice Address - Street 2: | |
Practice Address - City: | SAN FRANCISCO |
Practice Address - State: | CA |
Practice Address - Zip Code: | 94108-4007 |
Practice Address - Country: | US |
Practice Address - Phone: | 415-693-9139 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2013-05-15 |
Last Update Date: | 2013-05-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | 52987 | 1223D0001X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223D0001X | Dental Providers | Dentist | Dental Public Health | Group - Single Specialty |