Provider Demographics
NPI:1134267677
Name:KHESIN, YAKOV (LMP-C, NCTMB)
Entity type:Individual
Prefix:
First Name:YAKOV
Middle Name:
Last Name:KHESIN
Suffix:
Gender:M
Credentials:LMP-C, NCTMB
Other - Prefix:
Other - First Name:JACOB
Other - Middle Name:
Other - Last Name:KHESIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMP-C, NCTMB
Mailing Address - Street 1:1530 N 115TH ST STE 207
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8411
Mailing Address - Country:US
Mailing Address - Phone:206-355-6781
Mailing Address - Fax:206-523-1252
Practice Address - Street 1:1530 N 115TH ST STE 207
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8411
Practice Address - Country:US
Practice Address - Phone:206-355-6781
Practice Address - Fax:206-523-1252
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00010390174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist