Healthcare Provider Details

I. General information

NPI: 1245598200
Provider Name (Legal Business Name): DAREEN KHALAF MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2012
Last Update Date: 10/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 N LA BREA AVE
LOS ANGELES CA
90028-7505
US

IV. Provider business mailing address

1445 N LA BREA AVE
LOS ANGELES CA
90028-7505
US

V. Phone/Fax

Practice location:
  • Phone: 323-798-5158
  • Fax: 323-798-4914
Mailing address:
  • Phone: 323-798-5158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA122011
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: