Individual provider Active NPI

Michael Khaimov, PA-C

  • Physician Assistant
  • Forest Hills, NY
National Provider Identifier
1467310334
Registry record updated Jan 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
03498301 Issued in NY
Practice address
11247 Queens Blvd Ste 206
Forest Hills, NY 11375-7421
Phone
(800) 200-8196
NPI assigned
Jan 12, 2026
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 03498301 NY Primary

Addresses

Primary practice location

11247 Queens Blvd Ste 206
Forest Hills, NY 11375-7421

Mailing address

9810 64TH Ave Apt 5F
Rego Park, NY 11374-2502
Phone (718) 576-5110

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
03498301NYMDPhysician Assistant

NPI Registry JSON

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

{
    "created_epoch": "1768176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768176000000",
    "number": "1467310334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9810 64TH AVE APT 5F",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "113742502",
            "telephone_number": "718-576-5110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11247 QUEENS BLVD STE 206",
            "city": "FOREST HILLS",
            "state": "NY",
            "postal_code": "113757421",
            "telephone_number": "800-200-8196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAIMOV",
        "first_name": "MICHAEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2026-01-12",
        "last_updated": "2026-01-12",
        "certification_date": "2026-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "03498301",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest Hills, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.