Healthcare Provider Details

I. General information

NPI: 1619239910
Provider Name (Legal Business Name): NIAM HAKIM ADAMS LVN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 S ARROYO PKWY
PASADENA CA
91105-3911
US

IV. Provider business mailing address

5992 LINDENHURST AVE
LOS ANGELES CA
90036-3219
US

V. Phone/Fax

Practice location:
  • Phone: 626-403-2794
  • Fax:
Mailing address:
  • Phone: 609-357-8649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number262646
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: