MEDICARE: DR. MANOUTCHER KHALILI MD

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	207Q00000X	Family Medicine Physician	A52178	CA

General Provider Information

NPI Number	:	1861446841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANOUTCHER KHALILI MD

Provider Business Mailing Address
First Line	:	4111 VANALDEN AVE
Second Line	:
City	:	TARZANA
State	:	CA
Zip	:	91356-5516
Country	:	US
Telephone Number	:	818-757-7246
Fax Number	:	310-323-0216

Provider Business Practice Location Address
First Line	:	1146 W REDONDO BEACH BLVD
Second Line	:
City	:	GARDENA
State	:	CA
Zip	:	90247-3538
Country	:	US
Telephone Number	:	323-428-9999
Fax Number	:	310-323-0216

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

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	05/24/2016

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