Healthcare Provider Details

I. General information

NPI: 1336622893
Provider Name (Legal Business Name): ALI HAKIMI L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2018
Last Update Date: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 TELEGRAPH AVE
BERKELEY CA
94704-3321
US

IV. Provider business mailing address

2620 TELEGRAPH AVE
BERKELEY CA
94704-3321
US

V. Phone/Fax

Practice location:
  • Phone: 530-593-1584
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number17940
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: