Healthcare Provider Details

I. General information

NPI: 1922055128
Provider Name (Legal Business Name): YEVGENIY A KHAVKIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5380 S RAINBOW BLVD STE 306
LAS VEGAS NV
89118-1880
US

IV. Provider business mailing address

5380 S RAINBOW BLVD STE 306
LAS VEGAS NV
89118-1880
US

V. Phone/Fax

Practice location:
  • Phone: 702-888-1188
  • Fax: 702-476-8995
Mailing address:
  • Phone: 702-888-1188
  • Fax: 702-476-8995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number01066362A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number13271
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberD63005
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: