Healthcare Provider Details

I. General information

NPI: 1992545693
Provider Name (Legal Business Name): MYRIAM HAKIMEH DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

635 ALBANY ST
BOSTON MA
02118-3550
US

IV. Provider business mailing address

805 SONORA CT
SAN DIMAS CA
91773-1486
US

V. Phone/Fax

Practice location:
  • Phone: 626-554-8630
  • Fax:
Mailing address:
  • Phone: 626-554-8630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN10000397
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: