Provider Demographics
NPI:1780033076
Name:JAMA, YASIN
Entity Type:Individual
Prefix:
First Name:YASIN
Middle Name:
Last Name:JAMA
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 1:9810 DREW AVE S
Mailing Address - Street 2:APT 106
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-2771
Mailing Address - Country:US
Mailing Address - Phone:612-703-4514
Mailing Address - Fax:
Practice Address - Street 1:9810 DREW AVENUE SOUTH
Practice Address - Street 2:APARTMENT 106
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431
Practice Address - Country:US
Practice Address - Phone:612-703-4514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNW963240252118171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor