Healthcare Provider Details

I. General information

NPI: 1285131854
Provider Name (Legal Business Name): DANIEL GENNADIEVICH KHOKHORIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18TH MEDICAL GROUP UNIT 5142
APO AP
96368-5142
US

IV. Provider business mailing address

18TH MEDICAL GROUP UNIT 5142
APO AP
96368-5142
US

V. Phone/Fax

Practice location:
  • Phone: 907-551-4006
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number16404
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number16404
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: