Provider Demographics
NPI:1922055128
Name:KHAVKIN, YEVGENIY A (MD)
Entity Type:Individual
Prefix:
First Name:YEVGENIY
Middle Name:A
Last Name:KHAVKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 N TOWN CENTER DR
Mailing Address - Street 2:SUITE 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:SUITE 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
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01066362A207T00000X
MDD63005207T00000X
NV13271207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN408196000Medicaid
MD408196000Medicaid
MDI38381Medicare UPIN
IN233680DMedicare PIN
NVI38381Medicare UPIN
I38381Medicare UPIN
MD408196000Medicaid
MD408196000Medicaid