Provider Demographics
NPI:1952654592
Name:MEDICAL INSTITUTE OF IMMUNOLOGY AND INFECTIOUS DISEASES
Entity Type:Organization
Organization Name:MEDICAL INSTITUTE OF IMMUNOLOGY AND INFECTIOUS DISEASES
Other - Org Name:MIIID
Other - Org Type:Other Name
Authorized Official - Title/Position:CO-DIRECTOR/OWNER
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:323-663-6790
Mailing Address - Street 1:1300 N VERMONT AVE
Mailing Address - Street 2:SUITE 806
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6005
Mailing Address - Country:US
Mailing Address - Phone:323-663-6790
Mailing Address - Fax:323-663-6791
Practice Address - Street 1:1300 N VERMONT AVE
Practice Address - Street 2:SUITE 806
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6005
Practice Address - Country:US
Practice Address - Phone:323-663-6790
Practice Address - Fax:323-663-6791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-19
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66631207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1356335277OtherINDIVIDUAL PROVIDER NPI
CA1356335277OtherINDIVIDUAL PROVIDER NPI