Healthcare Provider Details

I. General information

NPI: 1912214503
Provider Name (Legal Business Name): KHALID MEDANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2010
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11860 WILSHIRE BLVD STE 100
LOS ANGELES CA
90025-6606
US

IV. Provider business mailing address

11860 WILSHIRE BLVD STE 100
LOS ANGELES CA
90025-6606
US

V. Phone/Fax

Practice location:
  • Phone: 747-326-0002
  • Fax:
Mailing address:
  • Phone: 747-326-0002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA133575
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberA133575
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301096858
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: