Healthcare Provider Details

I. General information

NPI: 1366565764
Provider Name (Legal Business Name): MAZIN S AL-HAKEEM M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NEWPORT CENTER DR SUITE 308
NEWPORT BEACH CA
92660-7501
US

IV. Provider business mailing address

200 NEWPORT CENTER DR SUITE 308
NEWPORT BEACH CA
92660-7501
US

V. Phone/Fax

Practice location:
  • Phone: 949-760-6200
  • Fax: 949-759-5658
Mailing address:
  • Phone: 949-760-6200
  • Fax: 949-759-5658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberG83959
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG83959
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: