Provider Demographics
NPI:1629858949
Name:HASSAN, MULKI ISSAK (LDH)
Entity Type:Individual
Prefix:
First Name:MULKI
Middle Name:ISSAK
Last Name:HASSAN
Suffix:
Gender:F
Credentials:LDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1237 WILDWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-9735
Mailing Address - Country:US
Mailing Address - Phone:763-843-6563
Mailing Address - Fax:
Practice Address - Street 1:331 WILLOW BND
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55428-3969
Practice Address - Country:US
Practice Address - Phone:763-762-8916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH11630124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist