Provider Demographics
NPI:1306940614
Name:HAKIM, LYADIA L (DDS)
Entity type:Individual
Prefix:
First Name:LYADIA
Middle Name:L
Last Name:HAKIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:
Other - Last Name:HAKIMZADEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11901 SANTA MONICA BLVD
Mailing Address - Street 2:#527
Mailing Address - City:WEST LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025
Mailing Address - Country:US
Mailing Address - Phone:310-473-6335
Mailing Address - Fax:
Practice Address - Street 1:6915 RESEDA BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4248
Practice Address - Country:US
Practice Address - Phone:818-784-2414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35113122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA335113-01OtherCA MEDICAL DENTAL PROGRAM
CA35113OtherBOARD OF DENTAL EXAMINERS