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General NPI Number Information
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NPI Number | 1154086049
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Entity Type | Individual
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Provider Name | ASHKAN JAVAHERI PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/04/2021
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Last Update Date | 10/28/2022
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Provider Practice Location Address
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Address Line | 16811 SOUTHWEST FWY
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City | SUGAR LAND
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State | TX
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Zip | 77479-4728
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Country | US
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Telephone | 281-690-4675
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Fax |
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Provider Business Mailing Address
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Address Line | 4710 LUNSFORD HOLLOW LN
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City | FRIENDSWOOD
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State | TX
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Zip | 77546-2513
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA15081
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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