Healthcare Provider Details

I. General information

NPI: 1942342472
Provider Name (Legal Business Name): ABDULLAH KHALIL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 N ROXBURY DR STE 207
BEVERLY HILLS CA
90210
US

IV. Provider business mailing address

436 N ROXBURY DR STE 207
BEVERLY HILLS CA
90210-5017
US

V. Phone/Fax

Practice location:
  • Phone: 310-385-8601
  • Fax: 310-492-9974
Mailing address:
  • Phone: 310-663-8554
  • Fax: 310-492-9974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA94269
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: