Provider Demographics
NPI:1700056462
Name:RAMIN KHALILI, DDS, INC.
Entity Type:Organization
Organization Name:RAMIN KHALILI, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALILI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-621-0687
Mailing Address - Street 1:1330 LONGWORTH DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-3629
Mailing Address - Country:US
Mailing Address - Phone:310-621-0687
Mailing Address - Fax:
Practice Address - Street 1:1330 LONGWORTH DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-3629
Practice Address - Country:US
Practice Address - Phone:310-621-0687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-08
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA566501223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty