Provider Demographics
NPI:1912465873
Name:FAHM, HAKEEM O
Entity Type:Individual
Prefix:
First Name:HAKEEM
Middle Name:O
Last Name:FAHM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9960 JOVITA AVE
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-3935
Mailing Address - Country:US
Mailing Address - Phone:818-445-4559
Mailing Address - Fax:
Practice Address - Street 1:9960 JOVITA AVE
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-3935
Practice Address - Country:US
Practice Address - Phone:818-445-4559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-08
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker