Healthcare Provider Details

I. General information

NPI: 1699579839
Provider Name (Legal Business Name): JASMINE MOHSEN HUSSEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2025
Last Update Date: 08/16/2025
Certification Date: 08/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 W WELLINGTON AVE
CHICAGO IL
60657-6709
US

IV. Provider business mailing address

900 FOLSOM ST APT 551
SAN FRANCISCO CA
94107-2173
US

V. Phone/Fax

Practice location:
  • Phone: 773-871-2188
  • Fax:
Mailing address:
  • Phone: 415-767-8277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.036210
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: