Provider Demographics
NPI:1023177664
Name:KHIBKIN, YURI
Entity type:Individual
Prefix:DR
First Name:YURI
Middle Name:
Last Name:KHIBKIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HOSPITAL DR STE 103
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-6603
Mailing Address - Country:US
Mailing Address - Phone:134-535-4933
Mailing Address - Fax:413-535-4934
Practice Address - Street 1:10 HOSPITAL DR STE 103
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-6603
Practice Address - Country:US
Practice Address - Phone:134-535-4933
Practice Address - Fax:413-535-4934
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA27939207L00000X
IN01077041A207L00000X, 208VP0014X
NY235329207L00000X
MA279391208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02670157Medicaid
IN201366750Medicaid