Provider Demographics
NPI:1821438987
Name:MIIID INCORPORATED
Entity Type:Organization
Organization Name:MIIID INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOMAYOON
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANLOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-397-0897
Mailing Address - Street 1:6360 WILSHIRE BLVD
Mailing Address - Street 2:STE 414
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5603
Mailing Address - Country:US
Mailing Address - Phone:323-397-0897
Mailing Address - Fax:
Practice Address - Street 1:6360 WILSHIRE BLVD
Practice Address - Street 2:STE 414
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5603
Practice Address - Country:US
Practice Address - Phone:323-397-0897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-03
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66631207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty