Provider Demographics
NPI:1942469689
Name:HAKIMZADEH, PASHA (DDS)
Entity Type:Individual
Prefix:
First Name:PASHA
Middle Name:
Last Name:HAKIMZADEH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3638 S CENTINELA AVE APT A
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-3124
Mailing Address - Country:US
Mailing Address - Phone:310-350-5763
Mailing Address - Fax:
Practice Address - Street 1:3638 S CENTINELA AVE APT A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-3124
Practice Address - Country:US
Practice Address - Phone:310-350-5763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-07
Last Update Date:2008-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57057122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist