Provider Demographics
NPI:1346550944
Name:K AND B SURGICAL GROUP, LLC
Entity Type:Organization
Organization Name:K AND B SURGICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KHALILI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-858-1242
Mailing Address - Street 1:9033 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1837
Mailing Address - Country:US
Mailing Address - Phone:310-858-1242
Mailing Address - Fax:310-858-1172
Practice Address - Street 1:9033 WILSHIRE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1837
Practice Address - Country:US
Practice Address - Phone:310-858-1242
Practice Address - Fax:310-858-1172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical