Provider Demographics
NPI:1588844294
Name:KASSEM, JEAN BRIAN (MD)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:BRIAN
Last Name:KASSEM
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 1:4540 CORDATA PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-8059
Mailing Address - Country:US
Mailing Address - Phone:360-676-8663
Mailing Address - Fax:360-676-8682
Practice Address - Street 1:4540 CORDATA PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-8059
Practice Address - Country:US
Practice Address - Phone:360-676-8663
Practice Address - Fax:360-676-8682
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60518533207W00000X
LAGETP.200552390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2042968Medicaid