Provider Demographics
NPI:1275744559
Name:IRAJ KHALKHALI, M.D., INC.
Entity Type:Organization
Organization Name:IRAJ KHALKHALI, M.D., INC.
Other - Org Name:WILLOW CENTER IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR RADIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:IRAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALKHALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-424-9906
Mailing Address - Street 1:500 W WILLOW ST STE 8
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2831
Mailing Address - Country:US
Mailing Address - Phone:562-424-9906
Mailing Address - Fax:562-427-9831
Practice Address - Street 1:500 W WILLOW ST STE 8
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2831
Practice Address - Country:US
Practice Address - Phone:562-424-9906
Practice Address - Fax:562-427-9831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44916261QR0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0207XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A320230Medicaid
CA00A320230Medicaid
CAA32023Medicare ID - Type Unspecified
CAA26673Medicare UPIN