Provider Demographics
NPI:1649207200
Name:HASSAN, YOUSSEF S (MD)
Entity Type:Individual
Prefix:
First Name:YOUSSEF
Middle Name:S
Last Name:HASSAN
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:PO BOX 8035
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-0035
Mailing Address - Country:US
Mailing Address - Phone:316-689-9135
Mailing Address - Fax:316-689-9102
Practice Address - Street 1:3311 E MURDOCK ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3054
Practice Address - Country:US
Practice Address - Phone:316-689-9989
Practice Address - Fax:316-689-9972
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS30556207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS103611OtherBCBS
KS203026OtherHPK
KS213920OtherCOVENTRY
KS7708OtherPHS
KS12393862OtherMULTIPLAN
KS20025490AMedicaid
KS213920OtherCOVENTRY
H55767Medicare UPIN