Provider Demographics
NPI:1164199501
Name:HASSAN, DANIYAL
Entity Type:Individual
Prefix:
First Name:DANIYAL
Middle Name:
Last Name:HASSAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5216 JILSON WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-3501
Mailing Address - Country:US
Mailing Address - Phone:925-980-1658
Mailing Address - Fax:951-386-0043
Practice Address - Street 1:5216 JILSON WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-3501
Practice Address - Country:US
Practice Address - Phone:925-980-1658
Practice Address - Fax:951-386-0043
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY8919980172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty