Provider Demographics
NPI:1255490660
Name:KHALEELI, MOYEEN (MD)
Entity Type:Individual
Prefix:
First Name:MOYEEN
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 1:4305 TORRANCE BLVD
Mailing Address - Street 2:SUITE #409
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503
Mailing Address - Country:US
Mailing Address - Phone:310-371-2110
Mailing Address - Fax:310-371-6102
Practice Address - Street 1:4305 TORRANCE BLVD
Practice Address - Street 2:SUITE #409
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503
Practice Address - Country:US
Practice Address - Phone:310-371-2110
Practice Address - Fax:310-371-6102
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26266207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A262660Medicaid
A83359Medicare UPIN
A26266Medicare ID - Type Unspecified