Basic Information
| Provider Information | |||||||||
| NPI: | 1659704963 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KHAYZNIKOV | ||||||||
| FirstName: | MAKSIM | ||||||||
| MiddleName: | YURYEVICH | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 HARRISON ST | ||||||||
| Address2: | 7TH FLOOR | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946123429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5106255356 | ||||||||
| FaxNumber: | 8777384262 | ||||||||
| Practice Location | |||||||||
| Address1: | 620 HOWARD AVE | ||||||||
| Address2: | |||||||||
| City: | ALTOONA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166014804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148892011 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2013 | ||||||||
| LastUpdateDate: | 01/26/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD61000079 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 2019-00094 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | A145405 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.