Provider Demographics
NPI:1255798625
Name:KHASIN, STANISLAV
Entity type:Individual
Prefix:MR
First Name:STANISLAV
Middle Name:
Last Name:KHASIN
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:SAMUEL
Other - Middle Name:
Other - Last Name:KHASIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1537 SHUMAKER WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-2673
Mailing Address - Country:US
Mailing Address - Phone:408-645-8535
Mailing Address - Fax:
Practice Address - Street 1:251 LLEWELLYN AVE
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-1940
Practice Address - Country:US
Practice Address - Phone:408-645-8535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-15
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician