Healthcare Provider Details

I. General information

NPI: 1356317705
Provider Name (Legal Business Name): SAIYID J HASAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2006
Last Update Date: 09/06/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5266 W 74TH ST
EDINA MN
55439-2223
US

IV. Provider business mailing address

5266 W 74TH ST
EDINA MN
55439-2223
US

V. Phone/Fax

Practice location:
  • Phone: 952-486-7858
  • Fax: 952-674-4641
Mailing address:
  • Phone: 952-486-7858
  • Fax: 952-674-4641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number102018
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: