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General NPI Number Information
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NPI Number | 1780470294
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Entity Type | Individual
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Provider Name | DINA YASSEN
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Gender | Female
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Dates
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Enumeration Date | 04/19/2025
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Last Update Date | 09/08/2025
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Provider Practice Location Address
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Address Line | 13013 FULLER AVE STE A
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City | GRANDVIEW
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State | MO
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Zip | 64030-2687
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Country | US
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Telephone | 816-214-5548
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Fax |
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Provider Business Mailing Address
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Address Line | 12762 71ST ST APT 212
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City | KENOSHA
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State | WI
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Zip | 53142-8430
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Country | US
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Telephone | 312-730-3333
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2019013833
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License Number State | MO
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