Provider Demographics
NPI:1871534578
Name:KHAVKIN, ALBERT (DO)
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:
Last Name:KHAVKIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:ALBERT
Other - Middle Name:
Other - Last Name:KHAVKIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:204 LUXAIRE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-4318
Mailing Address - Country:US
Mailing Address - Phone:702-531-4004
Mailing Address - Fax:
Practice Address - Street 1:204 LUXAIRE CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-4318
Practice Address - Country:US
Practice Address - Phone:702-531-4004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036109247174400000X
NV1185207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No174400000XOther Service ProvidersSpecialist