Provider Demographics
NPI:1861615791
Name:KHOKHLOV, EDWARD MICHAEL (ACUPUNCTURIST DIPL A)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:MICHAEL
Last Name:KHOKHLOV
Suffix:
Gender:M
Credentials:ACUPUNCTURIST DIPL A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 371274
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-5274
Mailing Address - Country:US
Mailing Address - Phone:303-693-2225
Mailing Address - Fax:303-693-7670
Practice Address - Street 1:4090 SOUTH PARKER RD
Practice Address - Street 2:SUITE 125
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014
Practice Address - Country:US
Practice Address - Phone:303-693-2225
Practice Address - Fax:303-693-7670
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO521171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist