Provider Demographics
NPI:1861453409
Name:JOSEPH, KASSAW A (MD)
Entity Type:Individual
Prefix:DR
First Name:KASSAW
Middle Name:A
Last Name:JOSEPH
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 1:200 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-9466
Mailing Address - Country:US
Mailing Address - Phone:606-439-6600
Mailing Address - Fax:606-439-6953
Practice Address - Street 1:200 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701
Practice Address - Country:US
Practice Address - Phone:606-439-6600
Practice Address - Fax:606-439-6953
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY41512207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100030010Medicaid
KYTP610OtherKENTUCKY MEDICAL LICENSE