Provider Demographics
NPI:1366956484
Name:HAKIMJAVADI, AHMAD (DDS)
Entity type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:
Last Name:HAKIMJAVADI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 HOUGH AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-4339
Mailing Address - Country:US
Mailing Address - Phone:925-448-1888
Mailing Address - Fax:
Practice Address - Street 1:170 EL CERRITO PLZ
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-4002
Practice Address - Country:US
Practice Address - Phone:925-294-0665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1021831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice