Healthcare Provider Details

I. General information

NPI: 1417192147
Provider Name (Legal Business Name): JAMAAL D. EL-KHAL, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2008
Last Update Date: 12/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8132 FIRESTONE BLVD SUITE#856
DOWNEY CA
90241-4231
US

IV. Provider business mailing address

8132 FIRESTONE BLVD SUITE#856
DOWNEY CA
90241-4231
US

V. Phone/Fax

Practice location:
  • Phone: 714-739-5959
  • Fax: 714-739-5974
Mailing address:
  • Phone: 714-739-5959
  • Fax: 714-739-5974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA102035
License Number StateCA

VIII. Authorized Official

Name: DR. JAMAAL DAVID EL-KHAL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-739-5959