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General NPI Number Information
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NPI Number | 1215564877
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Entity Type | Individual
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Provider Name | JASMINE KHACHATRIAN PA
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Gender | Female
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Dates
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Enumeration Date | 03/24/2020
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Last Update Date | 01/12/2023
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Provider Practice Location Address
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Address Line | 4836 VAN NUYS BLVD
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-2101
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Country | US
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Telephone | 818-907-7546
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Fax | 818-907-9506
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Provider Business Mailing Address
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Address Line | 1240 S WESTLAKE BLVD STE 205
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City | WESTLAKE VILLAGE
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State | CA
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Zip | 91361-1992
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Country | US
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Telephone | 805-495-0551
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Fax | 805-496-8079
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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 | PA13456
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License Number State | CA
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