Provider Demographics
NPI:1659356103
Name:BORIS KHAMISHON., PROF. CORP
Entity Type:Organization
Organization Name:BORIS KHAMISHON., PROF. CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROLOGY
Authorized Official - Prefix:MR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAMISHON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-582-2595
Mailing Address - Street 1:531 PALOMAR AVE
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-6143
Mailing Address - Country:US
Mailing Address - Phone:619-582-2595
Mailing Address - Fax:619-229-8006
Practice Address - Street 1:6699 ALVARADO RD
Practice Address - Street 2:2301
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5238
Practice Address - Country:US
Practice Address - Phone:619-582-2595
Practice Address - Fax:619-229-8006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-07
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty