Provider Demographics
NPI:1427005933
Name:YASSEAR, SIMON MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:MICHAEL
Last Name:YASSEAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SAID
Other - Middle Name:MAHMOUD
Other - Last Name:YASSIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6444 COYLE AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-0305
Mailing Address - Country:US
Mailing Address - Phone:916-965-5500
Mailing Address - Fax:916-965-9205
Practice Address - Street 1:6444 COYLE AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0305
Practice Address - Country:US
Practice Address - Phone:916-965-5500
Practice Address - Fax:916-965-9205
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31132207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A311320Medicaid
1598202OtherECFMG NUMBER
C03890Medicare UPIN
CA00A311320Medicaid