Healthcare Provider Details

I. General information

NPI: 1972490480
Provider Name (Legal Business Name): HAKAM JAMEEL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 06/18/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3509 SWEETWATER SPRINGS BLVD
SPRING VALLEY CA
91978-1082
US

IV. Provider business mailing address

3509 SWEETWATER SPRINGS BLVD STE 1
SPRING VALLEY CA
91978-1064
US

V. Phone/Fax

Practice location:
  • Phone: 619-670-4471
  • Fax:
Mailing address:
  • Phone: 619-670-4471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number111668
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: