Provider Demographics
NPI:1033302914
Name:KHALILI, RAMIN (DDS)
Entity type:Individual
Prefix:
First Name:RAMIN
Middle Name:
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 1:1330 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:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0522981223E0200X
CA566501223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics