Provider Demographics
NPI:1184887143
Name:JALILI, MEHDI (MD)
Entity type:Individual
Prefix:
First Name:MEHDI
Middle Name:
Last Name:JALILI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SEID MEHDI
Other - Middle Name:
Other - Last Name:JALILI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:101 THE CITY DR S
Mailing Address - Street 2:ROUTE 140
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 THE CITY DR S
Practice Address - Street 2:ROUTE 140
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3201
Practice Address - Country:US
Practice Address - Phone:714-456-6579
Practice Address - Fax:714-456-6832
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1139552085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology