Provider Demographics
NPI:1194944389
Name:KHAYAL, SAMIR JAMAL (DDS)
Entity type:Individual
Prefix:
First Name:SAMIR
Middle Name:JAMAL
Last Name:KHAYAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20707 ANZA AVE
Mailing Address - Street 2:#245
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503
Mailing Address - Country:US
Mailing Address - Phone:909-816-4543
Mailing Address - Fax:310-370-8154
Practice Address - Street 1:2001 E COMPTON BLVD
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221
Practice Address - Country:US
Practice Address - Phone:310-639-7970
Practice Address - Fax:310-639-7972
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50287122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist