Basic Information
Provider Information
NPI: 1003143207
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HAKIMI
FirstName: TIANA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1201 NORTHERN BLVD
Address2: SUITE 102
City: MANHASSET
State: NY
PostalCode: 110303037
CountryCode: US
TelephoneNumber: 5163655439
FaxNumber:  
Practice Location
Address1: 1201 NORTHERN BLVD
Address2: SUITE 102
City: MANHASSET
State: NY
PostalCode: 110303037
CountryCode: US
TelephoneNumber: 5163655439
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/09/2009
LastUpdateDate: 10/10/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223P0221X054443-1NYY Dental ProvidersDentistPediatric Dentistry

No ID Information.


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