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1609486968

NPI Code Detail

MEDICARE: MR. AHMET ERSIN YASSA MD

MEDICARE: MR. AHMET ERSIN YASSA MD

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	207R00000X	Internal Medicine Physician	125.075342	IL
2	246ZN0300X	Nephrology Specialist/Technologist	036.162548	IL
3	207RN0300X	Nephrology Physician	2025-00941	NC

General Provider Information

NPI Number	:	1609486968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. AHMET ERSIN YASSA MD

Provider Business Mailing Address
First Line	:	4600 N CLARENDON AVE APT 1210
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5793
Country	:	US
Telephone Number	:	773-739-0960
Fax Number	:

Provider Business Practice Location Address
First Line	:	317 WESTERN BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-6338
Country	:	US
Telephone Number	:	910-577-2360
Fax Number	:

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

Provider Enumeration Date	:	08/03/2020
Last Update Date	:	07/22/2025

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Directions to “ MR. AHMET ERSIN YASSA MD” Practice Location

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