Provider Demographics
NPI:1346273497
Name:KHALEELI, EMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:EMAD
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 1:6121 MONERO DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-3310
Mailing Address - Country:US
Mailing Address - Phone:310-793-4327
Mailing Address - Fax:310-793-4307
Practice Address - Street 1:4305 TORRANCE BLVD
Practice Address - Street 2:SUITE #301
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4409
Practice Address - Country:US
Practice Address - Phone:310-793-4327
Practice Address - Fax:310-793-4307
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68108207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D1013667OtherCLIA
CAA68108AMedicare ID - Type Unspecified
CA05D1013667OtherCLIA