Irina Khakhanov

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

F11210467 Issued in AZ

Practice address

5777 E Mayo Blvd
Phoenix, AZ 85054-4502

Phone

(646) 249-5910

NPI assigned

Dec 22, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bliss Medical Spa and Wellness PLLC

  • Family Medicine Physician
  • Glendale, AZ
  • NPI 1427873835
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1640131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640131200000",
    "number": "1417617002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15437 N 13TH AVE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850234484",
            "telephone_number": "646-249-5910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5777 E MAYO BLVD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850544502",
            "telephone_number": "646-249-5910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAKHANOV",
        "first_name": "IRINA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-12-22",
        "last_updated": "2021-12-22",
        "certification_date": "2021-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "F11210467",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• KG1 PLLC
• Karen Khachatryan
• Thaddeus Khachaturian, MD
• Shuaib M Khaderi, DMD
• Wais Ibrahim Khairandesh, LPC
• Khakwani and Mohammad Medical PC
• Harris Khan Khakwani, MD
• Dalia Khaled
• Hala Khaled
• Motassam Khaled

• Family Nurse Practitioner in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Family Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.