Active NPI
Jasan Khangura
- Pharmacist
- Olympia, WA
National Provider Identifier
1598487803
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH61296502
- Practice address
- 413 Lilly Rd NE
Olympia, WA 98506-5133 - Phone
- (360) 491-9480
- NPI assigned
- Sep 13, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PH61296502 | WA | Primary |
Addresses
Primary practice location
413 Lilly Rd NE
Olympia, WA 98506-5133
Mailing address
8260 155TH Ave SE
Newcastle, WA 98059-9279
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PH61296502 | Other | WA | WASHINGTON STATE DEPARTMENT OF HEALTH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PH61296502 | WA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1663027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663027200000",
"number": "1598487803",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8260 155TH AVE SE",
"city": "NEWCASTLE",
"state": "WA",
"postal_code": "980599279"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "413 LILLY RD NE",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "985065133",
"telephone_number": "360-491-9480"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHANGURA",
"first_name": "JASAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-09-13",
"last_updated": "2022-09-13",
"certification_date": "2022-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "PH61296502",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WASHINGTON STATE DEPARTMENT OF HEALTH",
"identifier": "PH61296502",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Olympia, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.