Healthcare Provider Details

I. General information

NPI: 1902122617
Provider Name (Legal Business Name): MOYEEN KHALEELI M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2010
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4305 TORRANCE BLVD 409
TORRANCE CA
90503-4409
US

IV. Provider business mailing address

4305 TORRANCE BLVD 409
TORRANCE CA
90503-4409
US

V. Phone/Fax

Practice location:
  • Phone: 310-371-2110
  • Fax: 310-371-6102
Mailing address:
  • Phone: 310-371-2110
  • Fax: 310-371-6102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA26266
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA26266
License Number StateCA

VIII. Authorized Official

Name: MOYEEN KHALEELI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-371-2110