Provider Demographics
NPI:1922359058
Name:HAKIMIRAD, BONNY (DDS)
Entity Type:Individual
Prefix:DR
First Name:BONNY
Middle Name:
Last Name:HAKIMIRAD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10636 WILSHIRE BLVD
Mailing Address - Street 2:APT 204
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4592
Mailing Address - Country:US
Mailing Address - Phone:310-525-0444
Mailing Address - Fax:
Practice Address - Street 1:10636 WILSHIRE BLVD
Practice Address - Street 2:APT 204
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4592
Practice Address - Country:US
Practice Address - Phone:310-525-0444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61873122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist