MEDICARE: DR. DANIEL GENNADIEVICH KHOKHORIN DO

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	390200000X	Student in an Organized Health Care Education/Training Program	58.035579	OH
2	208D00000X	General Practice Physician	16404	ND
3	2083A0100X	Aerospace Medicine Physician	16404	ND

General Provider Information

NPI Number	:	1285131854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL GENNADIEVICH KHOKHORIN DO

Provider Business Mailing Address
First Line	:	18TH MEDICAL GROUP
Second Line	:	UNIT 5142
City	:	APO
State	:	AP
Zip	:	96368-5142
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18TH MEDICAL GROUP
Second Line	:	UNIT 5142
City	:	APO
State	:	AP
Zip	:	96368-5142
Country	:	US
Telephone Number	:	907-551-4006
Fax Number	:

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

Provider Enumeration Date	:	04/10/2018
Last Update Date	:	06/17/2026

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