Provider Demographics
NPI:1306961693
Name:EMAD KHALEELI MD INC
Entity type:Organization
Organization Name:EMAD KHALEELI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALEELI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-793-4327
Mailing Address - Street 1:6121 MONERO DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-3310
Mailing Address - Country:US
Mailing Address - Phone:310-793-4327
Mailing Address - Fax:310-793-4307
Practice Address - Street 1:4305 TORRANCE BLVD
Practice Address - Street 2:SUITE #301
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4409
Practice Address - Country:US
Practice Address - Phone:310-793-4327
Practice Address - Fax:310-793-4307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68108207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D1013667OtherCLIA
CA00A68108OtherMEDICAL ID NUMBER
CA05D1013667OtherCLIA
CAA68108AMedicare ID - Type Unspecified