Provider Demographics
NPI:1942791934
Name:KHAIMOV, IOSIF JOSEPH
Entity type:Individual
Prefix:DR
First Name:IOSIF
Middle Name:JOSEPH
Last Name:KHAIMOV
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 1:6336 99TH ST APT 5H
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1988
Mailing Address - Country:US
Mailing Address - Phone:347-752-7117
Mailing Address - Fax:
Practice Address - Street 1:10250 62ND RD APT 1F
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1009
Practice Address - Country:US
Practice Address - Phone:347-752-7117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060573122300000X, 1223G0001X
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program