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General NPI Number Information
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NPI Number | 1780033076
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Entity Type | Individual
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Provider Name | YASIN JAMA
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Gender | Male
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Dates
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Enumeration Date | 06/07/2016
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Last Update Date | 06/07/2016
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Provider Practice Location Address
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Address Line | 9810 DREW AVENUE SOUTH APARTMENT 106
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City | BLOOMINGTON
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State | MN
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Zip | 55431
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Country | US
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Telephone | 612-703-4514
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Fax |
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Provider Business Mailing Address
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Address Line | 9810 DREW AVE S APT 106
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City | BLOOMINGTON
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State | MN
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Zip | 55431-2771
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Country | US
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Telephone | 612-703-4514
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | W963240252118
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License Number State | MN
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