Provider Demographics
NPI:1215904172
Name:KASS, DAN M (MD)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:M
Last Name:KASS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-0547
Mailing Address - Country:US
Mailing Address - Phone:843-663-8000
Mailing Address - Fax:843-663-8123
Practice Address - Street 1:4303 LIVE OAK DRIVE
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-9138
Practice Address - Country:US
Practice Address - Phone:843-663-8000
Practice Address - Fax:843-663-8123
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164677207R00000X
SC40402207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY42F141Medicare ID - Type Unspecified
NYB05266Medicare UPIN