# SAM GHALILI MD INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720453574
- **Authorized official:** DR. SAM GHALILI M.D. (OWNER)
- **Authorized official phone:** (213) 749-7110

## Contact information

- **Practice address:** 2101 S SAN PEDRO ST, LOS ANGELES, CA 90011-1125
- **Practice address phone:** (213) 845-8766
- **Practice address fax:** (213) 745-8704
- **Mailing address:** 2101 S SAN PEDRO ST, LOS ANGELES, CA 90011-1125
- **Mailing address phone:** (213) 845-8766
- **Mailing address fax:** (213) 745-8704

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | A88734 | CA | — |
| 208D00000X | General Practice Physician | — | CA | Yes |

## Other

- **Enumeration date:** 12/04/2015
- **Last updated:** 09/21/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | A088734 | — | CA |