Provider Demographics
NPI:1659493625
Name:ALHAKEEM, SULTAN
Entity Type:Individual
Prefix:DR
First Name:SULTAN
Middle Name:
Last Name:ALHAKEEM
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 1:200 NEWPORT CENTER DR STE 308
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7504
Mailing Address - Country:US
Mailing Address - Phone:949-760-6200
Mailing Address - Fax:949-760-0127
Practice Address - Street 1:200 NEWPORT CENTER DR STE 308
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7504
Practice Address - Country:US
Practice Address - Phone:949-760-6200
Practice Address - Fax:949-760-0127
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41587207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA41587Medicare ID - Type Unspecified