Healthcare Provider Details

I. General information

NPI: 1346550944
Provider Name (Legal Business Name): K AND B SURGICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 10/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9033 WILSHIRE BLVD SUITE 200
BEVERLY HILLS CA
90211-1837
US

IV. Provider business mailing address

9033 WILSHIRE BLVD SUITE 200
BEVERLY HILLS CA
90211-1837
US

V. Phone/Fax

Practice location:
  • Phone: 310-858-1242
  • Fax: 310-858-1172
Mailing address:
  • Phone: 310-858-1242
  • Fax: 310-858-1172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. THEODORE M KHALILI
Title or Position: PARTNER/MEMBER
Credential: M.D.
Phone: 310-858-1242