Provider Demographics
NPI:1811941982
Name:DAYEMO, KASSAMO (MD)
Entity type:Individual
Prefix:
First Name:KASSAMO
Middle Name:
Last Name:DAYEMO
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 80631
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29416-0631
Mailing Address - Country:US
Mailing Address - Phone:843-763-0503
Mailing Address - Fax:843-763-0514
Practice Address - Street 1:1606 ASHLEY RIVER RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5902
Practice Address - Country:US
Practice Address - Phone:843-763-0503
Practice Address - Fax:843-763-0514
Is Sole Proprietor?:No
Enumeration Date:2006-05-21
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19094207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCF73681Medicare UPIN
SCF736810281Medicare PIN