Healthcare Provider Details

I. General information

NPI: 1659624906
Provider Name (Legal Business Name): ISAAC HAKIM DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2012
Last Update Date: 10/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 W SUNSET BLVD STE 905
LOS ANGELES CA
90069-3710
US

IV. Provider business mailing address

9201 W SUNSET BLVD STE 905
LOS ANGELES CA
90069-3710
US

V. Phone/Fax

Practice location:
  • Phone: 310-271-7287
  • Fax: 310-271-8245
Mailing address:
  • Phone: 310-271-7287
  • Fax: 310-271-8245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number27142
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: