Provider Demographics
NPI:1013897743
Name:KHAITANOV, UMID
Entity type:Individual
Prefix:MR
First Name:UMID
Middle Name:
Last Name:KHAITANOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13499 BISCAYNE BLVD APT 410
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-2026
Mailing Address - Country:US
Mailing Address - Phone:305-910-1957
Mailing Address - Fax:
Practice Address - Street 1:13499 BISCAYNE BLVD APT 410
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-2026
Practice Address - Country:US
Practice Address - Phone:305-910-1957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty