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General NPI Number Information
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NPI Number | 1346550944
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Entity Type | Organization
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Legal Business Name | K AND B SURGICAL GROUP, LLC
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Dates
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Enumeration Date | 10/15/2010
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Last Update Date | 10/15/2010
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Provider Practice Location Address
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Address Line | 9033 WILSHIRE BLVD SUITE 200
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-1837
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Country | US
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Telephone | 310-858-1242
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Fax | 310-858-1172
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Provider Business Mailing Address
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Address Line | 9033 WILSHIRE BLVD SUITE 200
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-1837
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Country | US
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Telephone | 310-858-1242
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Fax | 310-858-1172
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Authorized Official
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Title or Position | PARTNER/MEMBER
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Name | MR. THEODORE M KHALILI
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Credential | M.D.
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Telephone | 310-858-1242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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