Provider Demographics
NPI:1588033310
Name:KASSA, DEREJE
Entity Type:Individual
Prefix:
First Name:DEREJE
Middle Name:
Last Name:KASSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7560 E HARVARD AVE
Mailing Address - Street 2:APT 308
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-3726
Mailing Address - Country:US
Mailing Address - Phone:720-577-9640
Mailing Address - Fax:
Practice Address - Street 1:7560 E HARVARD AVE
Practice Address - Street 2:APT 308
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-3726
Practice Address - Country:US
Practice Address - Phone:720-577-9640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)