Provider Demographics
NPI:1891969184
Name:GUSSOUS, YAZEED MAZEN (MBBS)
Entity Type:Individual
Prefix:
First Name:YAZEED
Middle Name:MAZEN
Last Name:GUSSOUS
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2495 HOSPITAL DR STE 460
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4172
Mailing Address - Country:US
Mailing Address - Phone:650-962-4617
Mailing Address - Fax:650-962-4618
Practice Address - Street 1:2495 HOSPITAL DR STE 460
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4172
Practice Address - Country:US
Practice Address - Phone:650-962-4617
Practice Address - Fax:650-962-4618
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN107051207X00000X
MN56898207X00000X
OH35129198207X00000X
CAA130401207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAENROLLEDMedicaid
MNENROLLEDMedicaid
IAENROLLEDMedicaid