Provider Demographics
NPI:1740073741
Name:ROB M KASSAN M D LLC
Entity type:Organization
Organization Name:ROB M KASSAN M D LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROB
Authorized Official - Middle Name:
Authorized Official - Last Name:KASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-650-7813
Mailing Address - Street 1:445 NUTCRACKER DR
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-7329
Mailing Address - Country:US
Mailing Address - Phone:310-650-7813
Mailing Address - Fax:
Practice Address - Street 1:1105 SE CENTENNIAL ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1343
Practice Address - Country:US
Practice Address - Phone:541-241-6471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-23
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care