Provider Demographics
NPI:1194050500
Name:HASSAN, KATY YASER (PA-C)
Entity type:Individual
Prefix:MS
First Name:KATY
Middle Name:YASER
Last Name:HASSAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:675 N SAINT CLAIR ST
Mailing Address - Street 2:GALTER 15-200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5975
Mailing Address - Country:US
Mailing Address - Phone:312-695-1463
Mailing Address - Fax:312-695-9183
Practice Address - Street 1:675 N SAINT CLAIR ST
Practice Address - Street 2:GALTER 15-200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5975
Practice Address - Country:US
Practice Address - Phone:312-695-1463
Practice Address - Fax:312-695-9183
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-03
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL085-003610363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL522620215Medicare PIN