Healthcare Provider Details

I. General information

NPI: 1023177664
Provider Name (Legal Business Name): DR. YURI KHIBKIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 HOSPITAL DR STE 103
HOLYOKE MA
01040-6603
US

IV. Provider business mailing address

10 HOSPITAL DR STE 103
HOLYOKE MA
01040-6603
US

V. Phone/Fax

Practice location:
  • Phone: 134-535-4933
  • Fax: 413-535-4934
Mailing address:
  • Phone: 134-535-4933
  • Fax: 413-535-4934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number279391
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number01077041A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number27939
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number235329
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: