Provider Demographics
NPI:1518979285
Name:KASS CLINICS, LLC
Entity Type:Organization
Organization Name:KASS CLINICS, LLC
Other - Org Name:CENTER FOR ELECTROLYSIS SKIN & LASER THERAPY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:W
Authorized Official - Last Name:KASS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:952-926-3311
Mailing Address - Street 1:2721 GLENHURST AVE
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-3909
Mailing Address - Country:US
Mailing Address - Phone:952-926-3311
Mailing Address - Fax:952-922-4492
Practice Address - Street 1:7104 W LAKE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-4417
Practice Address - Country:US
Practice Address - Phone:952-926-3311
Practice Address - Fax:952-922-4492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN33397174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
33G01TWOtherBLUE CROSS BLUE SHIELD
760000008Medicare ID - Type Unspecified
33G01TWOtherBLUE CROSS BLUE SHIELD