Healthcare Provider Details

I. General information

NPI: 1013657055
Provider Name (Legal Business Name): KEYAN JALILI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 S PARKER ST STE 150
ORANGE CA
92868-4761
US

IV. Provider business mailing address

1 UNIVERSITY OF NEW MEXICO # 106660
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 714-744-0900
  • Fax:
Mailing address:
  • Phone: 505-272-2610
  • Fax: 505-272-1300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberRS2022-0545
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number20A25951
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: