Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223E0200X | Endodontist | 052298 | NY |
Y | 1223E0200X | Endodontist | 56650 | CA |
NPI | 1033302914 |
---|---|
Provider Name | Ramin Khalili |
First Address | Los Angeles, CA 90049-3629 |
Second Address | Los Angeles, CA 90049-3629 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2007 |
Last Update Date | 31/01/2012 |