Provider Demographics
NPI:1386683258
Name:ISTWANI, AMMAR (MD)
Entity Type:Individual
Prefix:
First Name:AMMAR
Middle Name:
Last Name:ISTWANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 ATLANTIC AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3408
Mailing Address - Country:US
Mailing Address - Phone:562-491-9167
Mailing Address - Fax:562-491-7969
Practice Address - Street 1:1045 ATLANTIC AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813
Practice Address - Country:US
Practice Address - Phone:562-491-9167
Practice Address - Fax:562-491-7969
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80027174400000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHW8412OtherGROUP PTAN
CAP00479357OtherRR MEDICARE
CA00G800270OtherBCBS
CAHW8412AOtherPTAN/LEGACY PACIFIC HOSP
CAHW881OtherST MARYS PTAN
CA00G800270Medicaid
CAHW8412BOtherPTAN/LEGACY COMMUNITY HOSP
CAHW8412BOtherPTAN/LEGACY COMMUNITY HOSP
CAG55697Medicare UPIN
CAP00479357OtherRR MEDICARE
CA00G800270Medicaid
CAHW8412AOtherPTAN/LEGACY PACIFIC HOSP
CAWG80027IMedicare PIN