Provider Demographics
NPI:1326049420
Name:HASSAN, MOHAMMAD MASUD (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:MASUD
Last Name:HASSAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 W 119TH ST
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209-1101
Mailing Address - Country:US
Mailing Address - Phone:620-757-6748
Mailing Address - Fax:
Practice Address - Street 1:800 W FRONTIER LN
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061
Practice Address - Country:US
Practice Address - Phone:913-397-7800
Practice Address - Fax:913-397-7801
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA40777207P00000X
KS15-00782363A00000X
MO2013021151390200000X
KS04-38462207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program