MEDICARE: MANDANA KHALILI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A65182	CA
2	207RG0100X	Gastroenterology Physician	A65182	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184727687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANDANA KHALILI MD

Provider Business Mailing Address
First Line	:	PO BOX 743749
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90074-3749
Country	:	US
Telephone Number	:	415-514-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 POTRERO AVENUE
Second Line	:	RM 3D5
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94110-3518
Country	:	US
Telephone Number	:	415-206-8822
Fax Number	:	415-206-5199

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	04/28/2026

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Directions to “ MANDANA KHALILI MD” Practice Location

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