Provider Demographics
NPI:1891930657
Name:FAHIMY, FRED (DDS)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:
Last Name:FAHIMY
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 1:17752 BEACH BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-6838
Mailing Address - Country:US
Mailing Address - Phone:714-848-1515
Mailing Address - Fax:
Practice Address - Street 1:17752 BEACH BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-6838
Practice Address - Country:US
Practice Address - Phone:714-848-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA211221223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics