MEDICARE: HAKIMPOUR DENTAL CORP, INC.

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	1223G0001X	General Practice Dentistry	43167	CA

General Provider Information

NPI Number	:	1164745766
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAKIMPOUR DENTAL CORP, INC.

Provider Business Mailing Address
First Line	:	6055 MERIDIAN AVE STE 60
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95120-2700
Country	:	US
Telephone Number	:	408-927-0600
Fax Number	:

Provider Business Practice Location Address
First Line	:	6055 MERIDIAN AVE STE 60
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95120-2700
Country	:	US
Telephone Number	:	408-927-0600
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. REZA HAKIMPOUR
Credential	:	DDS
Telephone Number	:	408-927-0600

Provider Enumeration Date	:	03/10/2010
Last Update Date	:	03/10/2010

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