Provider Demographics
NPI:1912193137
Name:HAKIMI, MICHAEL NOURIEL (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:NOURIEL
Last Name:HAKIMI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16119 VANOWEN ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-4822
Mailing Address - Country:US
Mailing Address - Phone:818-904-6782
Mailing Address - Fax:818-904-5896
Practice Address - Street 1:16119 VANOWEN ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-4822
Practice Address - Country:US
Practice Address - Phone:818-904-6782
Practice Address - Fax:818-904-5896
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A13147207RC0000X
CA13147207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA400015031Medicare UPIN