IRINA KHAKHANOV
NPI 1417617002
Nurse Practitioner - Family in Phoenix, AZ
About Irina Khakhanov NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
IRINA KHAKHANOV (NPI 1417617002) is an individual family provider in Phoenix, Arizona, licensed in Arizona (F11210467) and active in the NPI registry since December 2021. She is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Irina Khakhanov is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 85054 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Irina Khakhanov's NPI number?
The NPI number for Irina Khakhanov is 1417617002. It was assigned to this individual provider in the NPPES registry on December 22, 2021.
Where is Irina Khakhanov located?
Irina Khakhanov practices at 5777 E Mayo Blvd, Phoenix, AZ 85054. The listed phone number is (646) 249-5910.
What is Irina Khakhanov's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Irina Khakhanov enrolled in Medicare?
Yes. Irina Khakhanov is registered in the Medicare PECOS enrollment system.
When was this NPI record last updated?
The NPPES record for Irina Khakhanov was last updated on December 22, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Irina Khakhanov · NPI 1417617002
Family physician in Phoenix, Arizona. Individual provider, active in the CMS NPPES registry since December 22, 2021.
## Identity
- **NPI:** 1417617002 (Entity type: Individual)
- **Enumerated:** December 22, 2021
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **State license:** F11210467 (Arizona)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 5777 E MAYO BLVD, Phoenix, AZ 85054-4502
- **Phone:** (646) 249-5910
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
## Record status
- **NPPES last updated:** December 22, 2021
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Source: [NPI Profile](https://npiprofile.com/npi/1417617002) · Data from the CMS NPPES public registry.