Healthcare Provider Details

I. General information

NPI: 1316625643
Provider Name (Legal Business Name): AMMAR A KHAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NMRTU BAHRAIN PSC 851, BOX 340
MANAMA BAHRAIN
09834
BH

IV. Provider business mailing address

NMRTU BAHRAIN PSC 851, BOX 340
MANAMA BAHRAIN
09834
BH

V. Phone/Fax

Practice location:
  • Phone: 949-245-5781
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14190235-9926
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: