Healthcare Provider Details

I. General information

NPI: 1598784811
Provider Name (Legal Business Name): NAGY KHALIL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1557 E FLORENCE AVE
LOS ANGELES CA
90001-2551
US

IV. Provider business mailing address

PO BOX 1529
LOS ANGELES CA
90001-0529
US

V. Phone/Fax

Practice location:
  • Phone: 323-584-1490
  • Fax:
Mailing address:
  • Phone: 323-584-1490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA56258
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: