Healthcare Provider Details

I. General information

NPI: 1427584283
Provider Name (Legal Business Name): JED HAMAD ASSAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5418 E ARROWHEAD PKWY
SIOUX FALLS SD
57110-0401
US

IV. Provider business mailing address

5418 E ARROWHEAD PKWY
SIOUX FALLS SD
57110-0401
US

V. Phone/Fax

Practice location:
  • Phone: 605-705-3322
  • Fax: 605-705-3322
Mailing address:
  • Phone: 605-705-3322
  • Fax: 605-705-3322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number14275
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number14275
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: