Provider Demographics
NPI:1285912048
Name:HAKIMZADEH, SARA (DDS)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:
Last Name:HAKIMZADEH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 FLINTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-1026
Mailing Address - Country:US
Mailing Address - Phone:415-827-3390
Mailing Address - Fax:
Practice Address - Street 1:301 W HUNTINGTON DR STE 509
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-1510
Practice Address - Country:US
Practice Address - Phone:626-446-3023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-28
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA604271223G0001X
NMDD35501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMDD3550OtherNM DENTAL LICENSE NUMBER
CA60427OtherCA DENAL LICENSE NUMBER