Healthcare Provider Details

I. General information

NPI: 1144470048
Provider Name (Legal Business Name): JEANNIE KHAVKIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEANNIE LINTON MD

II. Dates (important events)

Enumeration Date: 09/26/2008
Last Update Date: 11/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

653 N TOWN CENTER DR STE 308
LAS VEGAS NV
89144-0517
US

IV. Provider business mailing address

653 N TOWN CENTER DR STE 602
LAS VEGAS NV
89144-0520
US

V. Phone/Fax

Practice location:
  • Phone: 702-242-3223
  • Fax: 702-270-3224
Mailing address:
  • Phone: 702-888-1188
  • Fax: 702-673-1155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number13577
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number13577
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: