Maxwell Khanin

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

1001 Sneath LN
San Bruno, CA 94066-2308

Phone

(650) 243-9849

NPI assigned

Jul 16, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1563235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563321600000",
    "number": "1649823923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "412 PARAMOUNT DR",
            "city": "MILLBRAE",
            "state": "CA",
            "postal_code": "940301327",
            "telephone_number": "415-385-1527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 SNEATH LN",
            "city": "SAN BRUNO",
            "state": "CA",
            "postal_code": "940662308",
            "telephone_number": "650-243-9849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHANIN",
        "first_name": "MAXWELL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-16",
        "last_updated": "2019-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "72530271",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://csdautismservices.com/",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "412 Paramount Dr",
            "city": "Millbrae",
            "state": "CA",
            "country_code": "US",
            "postal_code": "940301327",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Takoma M Kero, D.D.S.
• Patrick Kerwin
• Zinira Khaibullina
• Haya Khalaf
• Yasmeen Khalid Khalil
• Zarmina Khattak
• Shakhnoza Khaydarova, BA,MA
• Karen V Kieras, RN
• Kim Xuan Tran D.D.S., Inc.
• Grace Kim, MS, RD

• Behavior Technician in San Bruno, CA
• Providers in San Bruno, CA by specialty
• Behavior Technician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2019; 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.