Healthcare Provider Details

I. General information

NPI: 1750403002
Provider Name (Legal Business Name): ALEXANDER HAKIM DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11645 WILSHIRE BLVD SUITE 1035
LOS ANGELES CA
90025
US

IV. Provider business mailing address

11645 WILSHIRE BLVD SUITE 1035
LOS ANGELES CA
90025
US

V. Phone/Fax

Practice location:
  • Phone: 310-826-4676
  • Fax: 310-826-4679
Mailing address:
  • Phone: 310-826-4676
  • Fax: 310-826-4679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number031622
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: