Healthcare Provider Details

I. General information

NPI: 1881258556
Provider Name (Legal Business Name): KIANOUSH KHALILI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2019
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LEAGUE UNIT 60021
IRVINE CA
92602-7000
US

IV. Provider business mailing address

1 LEAGUE UNIT 60021
IRVINE CA
92602-7000
US

V. Phone/Fax

Practice location:
  • Phone: 818-676-9291
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberA181683
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: