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General NPI Number Information
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NPI Number | 1063555340
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Entity Type | Individual
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Provider Name | ANNA ZHIVULKO-KHAVIN D.D.S
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Gender | Female
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 24026 70TH AVE
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City | DOUGLASTON
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State | NY
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Zip | 11362-1948
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Country | US
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Telephone | 718-428-4926
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Fax |
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Provider Business Mailing Address
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Address Line | 3550 81ST ST SUITE 1G
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-5068
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Country | US
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Telephone | 718-565-2461
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Fax | 718-565-3153
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 038332
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License Number State | NY
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