Healthcare Provider Details

I. General information

NPI: 1619532777
Provider Name (Legal Business Name): MUSTAFA HASAN AL-KHARSAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2019
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 CAMBRIDGE ST
KANSAS CITY KS
66160-8501
US

IV. Provider business mailing address

3901 RAINBOW BLVD MAILSTOP 2012
KANSAS CITY KS
66160-0001
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-1227
  • Fax: 505-272-6692
Mailing address:
  • Phone: 913-588-6970
  • Fax: 913-588-6965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number2025032804
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number04-49550
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2025032804
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number04-49550
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: