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General NPI Number Information
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NPI Number | 1851805717
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Entity Type | Organization
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Legal Business Name | IMANUEL KHALILI M.D.., INC
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Dates
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Enumeration Date | 11/29/2017
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Last Update Date | 07/28/2023
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Provider Practice Location Address
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Address Line | 9029 W PICO BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90035-1309
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Country | US
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Telephone | 424-355-0301
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Fax | 216-208-1348
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Provider Business Mailing Address
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Address Line | PO BOX 352338
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City | LOS ANGELES
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State | CA
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Zip | 90035-8932
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Country | US
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Telephone | 424-355-0301
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Fax | 424-355-0301
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Authorized Official
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Title or Position | CEO/ MD
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Name | DR. IMANUEL KHALILI
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Credential | MD
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Telephone | 424-355-0301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | A128772
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License Number State | CA
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