Provider Demographics
NPI:1821066325
Name:DAHHAN, GHASSAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:GHASSAN
Middle Name:S
Last Name:DAHHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1643 E PALMDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-4847
Mailing Address - Country:US
Mailing Address - Phone:661-948-1388
Mailing Address - Fax:661-948-1223
Practice Address - Street 1:1759 W AVENUE J
Practice Address - Street 2:#101
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2703
Practice Address - Country:US
Practice Address - Phone:661-948-1388
Practice Address - Fax:661-948-1223
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38553207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOA385530Medicaid
CA110040128OtherMEDICARE RAILROAD
CAOOA385530Medicaid
CAWA38553AMedicare ID - Type Unspecified