Provider Demographics
NPI:1124284195
Name:J.S. HASAN PLASTIC SURGERY, S.C.
Entity type:Organization
Organization Name:J.S. HASAN PLASTIC SURGERY, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAFAR
Authorized Official - Middle Name:S
Authorized Official - Last Name:HASAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-492-0520
Mailing Address - Street 1:2205 S WOLF RD
Mailing Address - Street 2:# 299
Mailing Address - City:HILLSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60162-2212
Mailing Address - Country:US
Mailing Address - Phone:734-945-1304
Mailing Address - Fax:
Practice Address - Street 1:2450 WOLF RD
Practice Address - Street 2:SUITE H
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-5643
Practice Address - Country:US
Practice Address - Phone:708-492-0520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-119900208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty