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General NPI Number Information
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NPI Number | 1275744559
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Entity Type | Organization
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Legal Business Name | IRAJ KHALKHALI, M.D., INC.
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 500 W WILLOW ST STE 8
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City | LONG BEACH
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State | CA
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Zip | 90806-2831
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Country | US
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Telephone | 562-424-9906
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Fax | 562-427-9831
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Provider Business Mailing Address
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Address Line | 500 W WILLOW ST STE 8
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City | LONG BEACH
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State | CA
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Zip | 90806-2831
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Country | US
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Telephone | 562-424-9906
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Fax | 562-427-9831
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Authorized Official
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Title or Position | MEDICAL DIRECTOR RADIOLOGIST
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Name | DR. IRAJ KHALKHALI
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Credential | M.D.
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Telephone | 562-424-9906
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0207X
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Taxonomy Name | Mobile Mammography Clinic/Center
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License Number | 44916
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License Number State | CA
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