Healthcare Provider Details

I. General information

NPI: 1982609756
Provider Name (Legal Business Name): SANJAY MASSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21277 W 153RD ST
OLATHE KS
66061-5424
US

IV. Provider business mailing address

21350 W 153RD ST
OLATHE KS
66061-5413
US

V. Phone/Fax

Practice location:
  • Phone: 913-890-7468
  • Fax: 913-529-2900
Mailing address:
  • Phone: 913-890-7468
  • Fax: 913-529-2900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number0451866
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0451866
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: