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General NPI Number Information
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NPI Number | 1124284195
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Entity Type | Organization
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Legal Business Name | J.S. HASAN PLASTIC SURGERY, S.C.
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Dates
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Enumeration Date | 07/30/2008
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Last Update Date | 07/30/2008
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Provider Practice Location Address
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Address Line | 2450 WOLF RD SUITE H
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City | WESTCHESTER
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State | IL
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Zip | 60154-5643
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Country | US
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Telephone | 708-492-0520
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Fax |
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Provider Business Mailing Address
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Address Line | 2205 S WOLF RD # 299
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City | HILLSIDE
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State | IL
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Zip | 60162-2212
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Country | US
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Telephone | 734-945-1304
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAFAR S HASAN
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Credential | M.D.
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Telephone | 708-492-0520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 036-119900
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License Number State | IL
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