Healthcare Provider Details

I. General information

NPI: 1265025464
Provider Name (Legal Business Name): JASSAM MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2021
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 SUPERIOR AVE STE 205
NEWPORT BEACH CA
92663-3667
US

IV. Provider business mailing address

520 SUPERIOR AVE STE 205
NEWPORT BEACH CA
92663-3667
US

V. Phone/Fax

Practice location:
  • Phone: 949-764-1444
  • Fax: 949-764-7398
Mailing address:
  • Phone: 949-764-1444
  • Fax: 949-764-7398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. YASIR JASSAM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 947-764-1444