Provider Demographics
NPI:1972346278
Name:KHAYZNIKOV MD INC
Entity type:Organization
Organization Name:KHAYZNIKOV MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAKSIM
Authorized Official - Middle Name:YURYEVICH
Authorized Official - Last Name:KHAYZNIKOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-406-4651
Mailing Address - Street 1:2108 N ST # 7607
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5712
Mailing Address - Country:US
Mailing Address - Phone:818-403-4651
Mailing Address - Fax:
Practice Address - Street 1:2108 N ST # 7607
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5712
Practice Address - Country:US
Practice Address - Phone:818-403-4651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-14
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty