Provider Demographics
NPI:1144470048
Name:KHAVKIN, JEANNIE (MD)
Entity type:Individual
Prefix:
First Name:JEANNIE
Middle Name:
Last Name:KHAVKIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JEANNIE
Other - Middle Name:
Other - Last Name:LINTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:653 N TOWN CENTER DR
Mailing Address - Street 2:STE 602
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-0520
Mailing Address - Country:US
Mailing Address - Phone:702-888-1188
Mailing Address - Fax:702-673-1155
Practice Address - Street 1:653 N TOWN CENTER DR STE 308
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-0517
Practice Address - Country:US
Practice Address - Phone:702-242-3223
Practice Address - Fax:702-270-3224
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13577207YS0123X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVDV281ZMedicare PIN