| Imanuel Khalili M.d.., Inc | |
|
9029 W Pico Blvd Los Angeles CA 90035-1309 | |
| (424) 355-0301 | |
| (216) 208-1348 |
| Full Name | Imanuel Khalili M.d.., Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 9029 W Pico Blvd, Los Angeles, California |
| Authorized Official Name and Position | Imanuel Khalili (CEO/ MD) |
| Authorized Official Contact | 4243550301 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Imanuel Khalili M.d.., Inc Po Box 352338 Los Angeles CA 90035-8932 Ph: (424) 355-0301 | Imanuel Khalili M.d.., Inc 9029 W Pico Blvd Los Angeles CA 90035-1309 Ph: (424) 355-0301 |
| NPI Number | 1851805717 |
|---|---|
| Provider Enumeration Date | 11/29/2017 |
| Last Update Date | 07/28/2023 |
| Medicare PECOS PAC ID | 5991064800 |
|---|---|
| Medicare Enrollment ID | O20180123002456 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851805717 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | A128772 (California) | Primary |
| Provider Name | Imanuel Khalili |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1447546627 PECOS PAC ID: 4385863109 Enrollment ID: I20140909002873 |
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