Provider Demographics
NPI:1508154428
Name:JASSAM, YASIR NIHAD (MBCHB MRCP(UK))
Entity Type:Individual
Prefix:DR
First Name:YASIR
Middle Name:NIHAD
Last Name:JASSAM
Suffix:
Gender:M
Credentials:MBCHB MRCP(UK)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
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:
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-395032084N0400X
MDD789172084N0400X
MO20200336242084N0400X
CAC1701832084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
86-2006117OtherIRS