Provider Demographics
NPI:1801812359
Name:HAKAKIAN, FARDIN (DPM)
Entity type:Individual
Prefix:
First Name:FARDIN
Middle Name:
Last Name:HAKAKIAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19228 VENTURA BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3101
Mailing Address - Country:US
Mailing Address - Phone:818-578-5125
Mailing Address - Fax:818-578-6039
Practice Address - Street 1:19228 VENTURA BLVD STE A
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3101
Practice Address - Country:US
Practice Address - Phone:818-578-5125
Practice Address - Fax:818-578-6039
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2025-02-05
Deactivation Date:2020-03-04
Deactivation Code:
Reactivation Date:2020-10-14
Provider Licenses
StateLicense IDTaxonomies
CAE3947213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E39470Medicaid
CA000E39471Medicaid
CA000E39470Medicaid
CA000E39471Medicaid