Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 2901018891 | MI |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 2901018891 | MI |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 59216 | CA |
N | 2086S0122X | Plastic and Reconstructive Surgery | 4301093272 | MI |
NPI | 1073734612 |
---|---|
Provider Name | Adel S. Khalil |
First Address | Berkeley, CA 94705-2050 |
Second Address | Berkeley, CA 94705-2050 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 24/10/2018 |