Provider Demographics
NPI:1447546627
Name:KHALILI, IMANUEL (MD)
Entity type:Individual
Prefix:DR
First Name:IMANUEL
Middle Name:
Last Name:KHALILI
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:PO BOX 352338
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-8932
Mailing Address - Country:US
Mailing Address - Phone:424-355-0301
Mailing Address - Fax:216-208-1348
Practice Address - Street 1:9029 W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1309
Practice Address - Country:US
Practice Address - Phone:424-355-0301
Practice Address - Fax:216-208-1348
Is Sole Proprietor?:No
Enumeration Date:2011-06-25
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA128772207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine