Provider Demographics
NPI:1366565764
Name:AL-HAKEEM, MAZIN S (MD)
Entity type:Individual
Prefix:DR
First Name:MAZIN
Middle Name:S
Last Name:AL-HAKEEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 NEWPORT CENTER DR
Mailing Address - Street 2:SUITE 308
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7501
Mailing Address - Country:US
Mailing Address - Phone:949-760-6200
Mailing Address - Fax:949-759-5658
Practice Address - Street 1:200 NEWPORT CENTER DR
Practice Address - Street 2:SUITE 308
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7501
Practice Address - Country:US
Practice Address - Phone:949-760-6200
Practice Address - Fax:949-759-5658
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83959173000000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Not Answered174400000XOther Service ProvidersSpecialist