Provider Demographics
NPI:1891865150
Name:SHEIBANI, KHALIL (MD)
Entity Type:Individual
Prefix:MR
First Name:KHALIL
Middle Name:
Last Name:SHEIBANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5856 CORPORATE AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-4754
Mailing Address - Country:US
Mailing Address - Phone:714-236-4000
Mailing Address - Fax:714-236-4006
Practice Address - Street 1:1001 N TUSTIN AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3502
Practice Address - Country:US
Practice Address - Phone:714-953-3381
Practice Address - Fax:714-953-3541
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37531207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A375310Medicaid
CAA88420Medicare UPIN
CAWA37531CMedicare PIN
CA00A375310Medicaid