Provider Demographics
NPI:1003824673
Name:KHALEELI, HOSAYN (MD)
Entity Type:Individual
Prefix:
First Name:HOSAYN
Middle Name:
Last Name:KHALEELI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2245 SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-5302
Mailing Address - Country:US
Mailing Address - Phone:310-320-3204
Mailing Address - Fax:310-320-0919
Practice Address - Street 1:2245 SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-5302
Practice Address - Country:US
Practice Address - Phone:310-320-3204
Practice Address - Fax:310-320-0919
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA062789207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A627890Medicaid
H58089Medicare UPIN
CA00A627890Medicaid