Provider Demographics
NPI:1164442000
Name:KHAYALI, MOHAMMAD R (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:R
Last Name:KHAYALI
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 1:44273 FRENCH CIR
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-6679
Mailing Address - Country:US
Mailing Address - Phone:951-927-7711
Mailing Address - Fax:
Practice Address - Street 1:395 N SAN JACINTO ST
Practice Address - Street 2:STE #A
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-3109
Practice Address - Country:US
Practice Address - Phone:951-652-6564
Practice Address - Fax:951-765-9875
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA299432084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A299430Medicaid
CAA29943OtherLICENSE
CAA29943OtherLICENSE