Provider Demographics
NPI:1538141577
Name:HASSOUN, JOSEPH KEN (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:KEN
Last Name:HASSOUN
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 1:20 MEDICAL VILLAGE DR
Mailing Address - Street 2:MILLENIUM ANESTHESIA LLC
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-5401
Mailing Address - Country:US
Mailing Address - Phone:859-341-7246
Mailing Address - Fax:859-341-7867
Practice Address - Street 1:311 STRAIGHT ST
Practice Address - Street 2:MILLENIUM ANESTHESIA LLC
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-1018
Practice Address - Country:US
Practice Address - Phone:859-341-7246
Practice Address - Fax:859-341-7867
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35078819H207L00000X
KY37537207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
311585770OtherTAX ID
000000634027OtherANTHEM
OH2363571Medicaid
000000257481OtherANTHEM BLUE SHIELD
IN200402560Medicaid
5296039OtherCIGNA
KY64058472OtherMEDICAID
000000257481OtherANTHEM BLUE SHIELD
OH2363571Medicaid
KY64058472OtherMEDICAID
E10586Medicare UPIN
050089261Medicare PIN
HA4091891Medicare PIN