Provider Demographics
NPI:1477516854
Name:KASSAM, YASMIN BADRUDIN
Entity Type:Individual
Prefix:DR
First Name:YASMIN
Middle Name:BADRUDIN
Last Name:KASSAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11311 BRIDGEPORT WAY SW STE 100
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3096
Mailing Address - Country:US
Mailing Address - Phone:253-985-6490
Mailing Address - Fax:
Practice Address - Street 1:11311 BRIDGEPORT WAY SW STE 100
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3096
Practice Address - Country:US
Practice Address - Phone:253-985-6490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA072957207RR0500X
CT032080207RR0500X
WAMD60871380207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC817753Medicaid
SCSCE1025019OtherMEDICARE PIN
WA2106702Medicaid