Provider Demographics
NPI:1952946808
Name:KHAIMOV, YULIANNA
Entity type:Individual
Prefix:
First Name:YULIANNA
Middle Name:
Last Name:KHAIMOV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15330 77TH RD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-3425
Mailing Address - Country:US
Mailing Address - Phone:917-769-2067
Mailing Address - Fax:
Practice Address - Street 1:15330 77TH RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-3425
Practice Address - Country:US
Practice Address - Phone:917-769-2067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency