Healthcare Provider Details

I. General information

NPI: 1306929708
Provider Name (Legal Business Name): ABDOLLAH GILANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 04/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3392 MOTOR AVE
LOS ANGELES CA
90034-3712
US

IV. Provider business mailing address

3392 MOTOR AVE
LOS ANGELES CA
90034-3712
US

V. Phone/Fax

Practice location:
  • Phone: 310-202-1133
  • Fax: 310-202-1139
Mailing address:
  • Phone: 310-858-5090
  • Fax: 310-424-3404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberC39975
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: