Healthcare Provider Details

I. General information

NPI: 1316354020
Provider Name (Legal Business Name): YASMIN HASSOUN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2014
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVENUE MLC 2000
CINCINNATI OH
45229
US

IV. Provider business mailing address

3333 BURNET AVENUE MLC 2000
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-6771
  • Fax: 513-636-5835
Mailing address:
  • Phone: 513-636-6771
  • Fax: 513-636-5835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number57.024096
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number57.024096
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number35.136987
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: