Healthcare Provider Details

I. General information

NPI: 1932279106
Provider Name (Legal Business Name): BEVERLY HILLS ORTHODONTIC GROUP F. ISAAC HAKIM, D.M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 W SUNSET BLVD SUITE 905
LOS ANGELES CA
90069-3701
US

IV. Provider business mailing address

9201 W SUNSET BLVD SUITE 905
LOS ANGELES CA
90069-3701
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: DR. F. ISAAC HAKIM
Title or Position: C.E.O.
Credential: D.M.D.
Phone: 310-271-7287