Provider Demographics
NPI:1588695423
Name:HEKIMIAN, KHOREN (DO)
Entity type:Individual
Prefix:
First Name:KHOREN
Middle Name:
Last Name:HEKIMIAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 W DUVAL
Mailing Address - Street 2:
Mailing Address - City:TROUP
Mailing Address - State:TX
Mailing Address - Zip Code:75789
Mailing Address - Country:US
Mailing Address - Phone:903-842-3018
Mailing Address - Fax:903-842-4585
Practice Address - Street 1:705 W DUVAL
Practice Address - Street 2:
Practice Address - City:TROUP
Practice Address - State:TX
Practice Address - Zip Code:75789
Practice Address - Country:US
Practice Address - Phone:903-842-3018
Practice Address - Fax:903-842-4585
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5844207RG0300X, 208600000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167475602Medicaid
TX167475602Medicaid
A67022Medicare UPIN