=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356317705
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAIYID J HASAN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2006
-----------------------------------------------------
Last Update Date | 04/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7731 FLYING CLOUD DR
-----------------------------------------------------
City | EDEN PRAIRIE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55344-3708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 962-486-7858
-----------------------------------------------------
Fax | 952-674-4641
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7731 FLYING CLOUD DR
-----------------------------------------------------
City | EDEN PRAIRIE
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55344-3708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 962-486-7858
-----------------------------------------------------
Fax | 952-674-4641
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 102018
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------