Provider Demographics
NPI:1174507313
Name:KASSA, SENTAYEHU (MD)
Entity Type:Individual
Prefix:
First Name:SENTAYEHU
Middle Name:
Last Name:KASSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8224 PARK LN STE 130
Practice Address - Street 2:VICKERY HEALTH CENTER
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-6021
Practice Address - Country:US
Practice Address - Phone:214-266-0350
Practice Address - Fax:214-696-3776
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2012-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6620207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX107492404Medicaid
TX107492405Medicaid
TX107492411Medicaid
TX107492412Medicaid
TX84678FOtherBLUE CROSS BLUE SHIELD
TX107492413Medicaid
TX107492403Medicaid
TX107492406Medicaid
TX107492408Medicaid
TX107492407Medicaid
TX107492409Medicaid
TX107492414Medicaid
TX107492401Medicaid
TX107492410Medicaid
TX107492406Medicaid
TX107492412Medicaid