MEDICARE: SOHAIL HAKIMI DDS DENTAL GROUP

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	1223D0001X	Public Health Dentistry

General Provider Information

NPI Number	:	1609556018
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOHAIL HAKIMI DDS DENTAL GROUP

Provider Business Mailing Address
First Line	:	13602 SAN ANTONIO DR
Second Line	:
City	:	NORWALK
State	:	CA
Zip	:	90650-4029
Country	:	US
Telephone Number	:	562-863-9228
Fax Number	:

Provider Business Practice Location Address
First Line	:	13602 SAN ANTONIO DR
Second Line	:
City	:	NORWALK
State	:	CA
Zip	:	90650-4029
Country	:	US
Telephone Number	:	562-863-9228
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	RAMILEINE RODRIGUEZ
Credential	:
Telephone Number	:	562-972-6327

Provider Enumeration Date	:	07/20/2023
Last Update Date	:	07/20/2023

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