Provider Demographics
NPI:1790025492
Name:HOSAYN KHALEELI, M D INC.
Entity Type:Organization
Organization Name:HOSAYN KHALEELI, M D INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOSAYN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALEELI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-320-3204
Mailing Address - Street 1:2245 SEPULVEDA BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-5302
Mailing Address - Country:US
Mailing Address - Phone:310-320-3204
Mailing Address - Fax:310-320-0919
Practice Address - Street 1:2245 SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-5302
Practice Address - Country:US
Practice Address - Phone:310-320-3204
Practice Address - Fax:310-320-0919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-18
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62789261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH58089Medicare UPIN