1194050500 NPI number — MS. KATY YASER HASSAN PA-C

Table of content: MS. KATY YASER HASSAN PA-C (NPI 1194050500)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194050500 NPI number — MS. KATY YASER HASSAN PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HASSAN
Provider First Name:
KATY
Provider Middle Name:
YASER
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194050500
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
675 N SAINT CLAIR ST
Provider Second Line Business Mailing Address:
GALTER 15-200
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60611-5975
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-695-1463
Provider Business Mailing Address Fax Number:
312-695-9183

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
675 N SAINT CLAIR ST
Provider Second Line Business Practice Location Address:
GALTER 15-200
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60611-5975
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-695-1463
Provider Business Practice Location Address Fax Number:
312-695-9183
Provider Enumeration Date:
10/03/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  085-003610 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)