Provider Demographics
NPI:1265025464
Name:JASSAM MD PC
Entity Type:Organization
Organization Name:JASSAM MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YASIR
Authorized Official - Middle Name:
Authorized Official - Last Name:JASSAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:947-764-1444
Mailing Address - Street 1:520 SUPERIOR AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3667
Mailing Address - Country:US
Mailing Address - Phone:949-764-1444
Mailing Address - Fax:949-764-7398
Practice Address - Street 1:520 SUPERIOR AVE STE 205
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3667
Practice Address - Country:US
Practice Address - Phone:949-764-1444
Practice Address - Fax:949-764-7398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty