Provider Demographics
NPI:1679825483
Name:KHAVKIN CLINIC PLLC
Entity Type:Organization
Organization Name:KHAVKIN CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YEVGENIY
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAVKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-888-1188
Mailing Address - Street 1:653 N TOWN CENTER DR
Mailing Address - Street 2:STE. 602
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-0514
Mailing Address - Country:US
Mailing Address - Phone:702-888-1188
Mailing Address - Fax:702-476-8995
Practice Address - Street 1:653 N TOWN CENTER DR
Practice Address - Street 2:STE. 602
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-0514
Practice Address - Country:US
Practice Address - Phone:702-888-1188
Practice Address - Fax:702-476-8995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-04
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1185207L00000X
NV16579207LP2900X
NV13271207T00000X
NV15590207T00000X
AZ50337207T00000X
AZ44750207T00000X
NV13577207YS0123X
NV9962207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Multi-Specialty
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Multi-Specialty