Healthcare Provider Details

I. General information

NPI: 1689784449
Provider Name (Legal Business Name): RAMIN NMI KHALILI MD FACS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 04/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 CONGRESS ST SUITE 301
PASADENA CA
91105-3024
US

IV. Provider business mailing address

39 CONGRESS ST SUITE 301
PASADENA CA
91105-3024
US

V. Phone/Fax

Practice location:
  • Phone: 626-486-0184
  • Fax: 626-486-0217
Mailing address:
  • Phone: 626-486-0184
  • Fax: 626-486-0217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberG76811
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: