MEDICARE: RAMIN KHALILI, DDS, INC.

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	56650	CA

General Provider Information

NPI Number	:	1700056462
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RAMIN KHALILI, DDS, INC.

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	:	ENDODONTIST
Name	:	DR. RAMIN KHALILI
Credential	:	DDS
Telephone Number	:	310-621-0687

Provider Enumeration Date	:	03/08/2008
Last Update Date	:	01/16/2012

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