Provider Demographics
NPI:1801214853
Name:NILOO MEDICAL GROUP INC
Entity Type:Organization
Organization Name:NILOO MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:MOALLEMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-796-0500
Mailing Address - Street 1:4762 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-3026
Mailing Address - Country:US
Mailing Address - Phone:323-796-0500
Mailing Address - Fax:323-796-0558
Practice Address - Street 1:4762 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-3026
Practice Address - Country:US
Practice Address - Phone:323-796-0500
Practice Address - Fax:323-796-0558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-06
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty