Provider Demographics
NPI:1518273028
Name:JEANNIE KHAVKIN MD PC
Entity Type:Organization
Organization Name:JEANNIE KHAVKIN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAVKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-242-3223
Mailing Address - Street 1:653 N TOWN CENTER DR STE 308
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-0517
Mailing Address - Country:US
Mailing Address - Phone:702-242-3223
Mailing Address - Fax:702-270-3224
Practice Address - Street 1:653 N TOWN CENTER DR STE 308
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-0517
Practice Address - Country:US
Practice Address - Phone:702-242-3223
Practice Address - Fax:702-270-3224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty