=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306940614
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYADIA L HAKIM DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6915 RESEDA BLVD SUITE 6
-----------------------------------------------------
City | RESEDA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91335-4248
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-784-2414
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11901 SANTA MONICA BLVD #527
-----------------------------------------------------
City | WEST LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-473-6335
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 35113
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------