1356455042 NPI number — DR. LAURA KIM HASSEN MD

Table of content: DR. LAURA KIM HASSEN MD (NPI 1356455042)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356455042 NPI number — DR. LAURA KIM HASSEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HASSEN
Provider First Name:
LAURA
Provider Middle Name:
KIM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1356455042
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9900 INDEPENDENCE PARK DR
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23233-1473
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-747-1855
Provider Business Mailing Address Fax Number:
804-762-8837

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7347 BELL CREEK RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
MECHANICSVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23111-3504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-559-9430
Provider Business Practice Location Address Fax Number:
804-559-2037
Provider Enumeration Date:
08/18/2006

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: 208000000X , with the licence number:  0101-237956 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 409034 . This is a "SOUTHERN HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 182314 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".