MEDICARE: INNA KHVAL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	214867	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134150063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INNA KHVAL MD

Provider Business Mailing Address
First Line	:	3090 RICHMOND RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-1971
Country	:	US
Telephone Number	:	718-351-1949
Fax Number	:	718-351-2569

Provider Business Practice Location Address
First Line	:	3090 RICHMOND RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-1937
Country	:	US
Telephone Number	:	718-351-1949
Fax Number	:	718-351-2569

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	10/13/2023

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Directions to “ INNA KHVAL MD” Practice Location

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