Provider Demographics
NPI:1689784449
Name:KHALILI, RAMIN NMI (MD FACS)
Entity Type:Individual
Prefix:
First Name:RAMIN
Middle Name:NMI
Last Name:KHALILI
Suffix:
Gender:M
Credentials:MD FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 CONGRESS ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3024
Mailing Address - Country:US
Mailing Address - Phone:626-486-0184
Mailing Address - Fax:626-486-0217
Practice Address - Street 1:39 CONGRESS ST
Practice Address - Street 2:SUITE 301
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3024
Practice Address - Country:US
Practice Address - Phone:626-486-0184
Practice Address - Fax:626-486-0217
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76811208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW21864OtherGROUP PTAN
CAW21864OtherGROUP PTAN
G23842Medicare UPIN