Provider Demographics
NPI:1659315133
Name:KHALIL, MICHAEL ELHAMI (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ELHAMI
Last Name:KHALIL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4204 WOODLEIGH LN
Mailing Address - Street 2:
Mailing Address - City:LA CANADA FLINTRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91011-3537
Mailing Address - Country:US
Mailing Address - Phone:323-240-4949
Mailing Address - Fax:818-790-7139
Practice Address - Street 1:17113 ARROW BLVD
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-3948
Practice Address - Country:US
Practice Address - Phone:909-822-3003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA445001223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics