Provider Demographics
NPI:1194295659
Name:KASSISIEH, DAVID KOSTA
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:KOSTA
Last Name:KASSISIEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 NEVADA ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-3606
Mailing Address - Country:US
Mailing Address - Phone:702-350-3400
Mailing Address - Fax:
Practice Address - Street 1:760 NEVADA ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-3606
Practice Address - Country:US
Practice Address - Phone:702-350-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1404035887Medicaid