MEDICARE: MAHSA HAKIM DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	52987	CA

General Provider Information

NPI Number	:	1063586998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAHSA HAKIM DDS

Provider Business Mailing Address
First Line	:	450 SUTTER ST
Second Line	:	SUITE 1326
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94108-4206
Country	:	US
Telephone Number	:	408-515-4297
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 SUTTER ST
Second Line	:	SUITE 1326
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94108-4206
Country	:	US
Telephone Number	:	408-515-4297
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	07/24/2009

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