Provider Demographics
NPI:1386483048
Name:HAKIMIAN, SURNA
Entity type:Individual
Prefix:
First Name:SURNA
Middle Name:
Last Name:HAKIMIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 WASHINGTON ST UNIT 2104
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1652
Mailing Address - Country:US
Mailing Address - Phone:321-262-7693
Mailing Address - Fax:
Practice Address - Street 1:742 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01905-2426
Practice Address - Country:US
Practice Address - Phone:781-671-5005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-22
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN10000218122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist