Healthcare Provider Details

I. General information

NPI: 1093938458
Provider Name (Legal Business Name): MUHAMMED ASIF YASIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 01/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4113 WILLIAMS BLVD
KENNER LA
70065
US

IV. Provider business mailing address

P.O. BOX 326
KENNER LA
70063
US

V. Phone/Fax

Practice location:
  • Phone: 786-457-7210
  • Fax:
Mailing address:
  • Phone: 786-457-7210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084D0003X
TaxonomyDiagnostic Neuroimaging (Psychiatry & Neurology) Physician
License NumberR9324
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD203266
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: