MEDICARE: JESSICA KASSIS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	A105126	CA

General Provider Information

NPI Number	:	1033394424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA KASSIS M.D.

Provider Business Mailing Address
First Line	:	125 DOHERTY WAY
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94061-4113
Country	:	US
Telephone Number	:	650-504-0294
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 PORTOLA RD STE A
Second Line	:
City	:	PORTOLA VALLEY
State	:	CA
Zip	:	94028-7852
Country	:	US
Telephone Number	:	650-585-3272
Fax Number	:	650-860-1830

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2008
Last Update Date	:	04/14/2025

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