Provider Demographics
NPI:1497059406
Name:KHASHAN, AMMAR (PA-C)
Entity Type:Individual
Prefix:
First Name:AMMAR
Middle Name:
Last Name:KHASHAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:710 COMMERCE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-4925
Mailing Address - Country:US
Mailing Address - Phone:651-968-5050
Mailing Address - Fax:651-968-5900
Practice Address - Street 1:3910 VISTA WAY STE 106
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4513
Practice Address - Country:US
Practice Address - Phone:760-941-2000
Practice Address - Fax:760-941-4900
Is Sole Proprietor?:No
Enumeration Date:2011-01-05
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN1521363A00000X
MN10880363A00000X
CA56687363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN970005103Medicare PIN