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NPI Code Detail

MEDICARE: DR. ILYA L KHAMISHON M.D.

MEDICARE: DR. ILYA L KHAMISHON M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208M00000XHospitalist PhysicianA54344CA

General Provider Information

NPI Number : 1275517062
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ILYA L KHAMISHON M.D.
Provider Business Mailing Address
First Line : 3400 DATA DR
Second Line :
City : RANCHO CORDOVA
State : CA
Zip : 95670-7956
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1650 CREEKSIDE DR STE 170
Second Line :
City : FOLSOM
State : CA
Zip : 95630-3400
Country : US
Telephone Number : 916-986-4426
Fax Number : 916-986-4434
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2005
Last Update Date : 04/14/2025

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