Healthcare Provider Details

I. General information

NPI: 1588695423
Provider Name (Legal Business Name): KHOREN HEKIMIAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 W DUVAL
TROUP TX
75789
US

IV. Provider business mailing address

705 W DUVAL
TROUP TX
75789
US

V. Phone/Fax

Practice location:
  • Phone: 903-842-3018
  • Fax: 903-842-4585
Mailing address:
  • Phone: 903-842-3018
  • Fax: 903-842-4585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberG5844
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG5844
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG5844
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: