Provider Demographics
NPI:1588136535
Name:KHALILI, ABDUL AZEEM MKHER (DDS)
Entity type:Individual
Prefix:
First Name:ABDUL AZEEM
Middle Name:MKHER
Last Name:KHALILI
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 1:4150 TRUXEL RD STE B
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-3761
Mailing Address - Country:US
Mailing Address - Phone:916-515-0005
Mailing Address - Fax:
Practice Address - Street 1:4150 TRUXEL RD STE B
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-3761
Practice Address - Country:US
Practice Address - Phone:916-515-0005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-31
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1034511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice