MEDICARE: RAMIN KHALILI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	052298	NY
2	1223E0200X	Endodontics	56650	CA

General Provider Information

NPI Number	:	1033302914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAMIN KHALILI DDS

Provider Business Mailing Address
First Line	:	1330 LONGWORTH DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-3629
Country	:	US
Telephone Number	:	310-621-0687
Fax Number	:

Provider Business Practice Location Address
First Line	:	1330 LONGWORTH DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-3629
Country	:	US
Telephone Number	:	310-621-0687
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2007
Last Update Date	:	01/31/2012

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Directions to “ RAMIN KHALILI DDS” Practice Location

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