Healthcare Provider Details

I. General information

NPI: 1639515752
Provider Name (Legal Business Name): HAKIM DENTAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 05/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 SUTTER ST RM 1326
SAN FRANCISCO CA
94108-4007
US

IV. Provider business mailing address

450 SUTTER ST RM 1326
SAN FRANCISCO CA
94108-4007
US

V. Phone/Fax

Practice location:
  • Phone: 415-693-9139
  • Fax:
Mailing address:
  • Phone: 415-693-9139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number52987
License Number StateCA

VIII. Authorized Official

Name: MAHSA HAKIM
Title or Position: DENTIST
Credential: DDS
Phone: 415-693-9139