Provider Demographics
NPI:1528035839
Name:KHALILI, SUZANNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:
Last Name:KHALILI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 W ADAMS BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-2318
Mailing Address - Country:US
Mailing Address - Phone:213-765-8161
Mailing Address - Fax:213-765-0240
Practice Address - Street 1:1105 W ADAMS BLVD
Practice Address - Street 2:STE 114
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-2318
Practice Address - Country:US
Practice Address - Phone:213-765-8161
Practice Address - Fax:213-765-0240
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41096122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA954633649OtherTAX ID NUMBER