Provider Demographics
NPI:1306005145
Name:SASAN, FAHIMEH (DO)
Entity type:Individual
Prefix:
First Name:FAHIMEH
Middle Name:
Last Name:SASAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 S DESPLAINES ST STE 201
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-5514
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:102 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-6902
Practice Address - Country:US
Practice Address - Phone:347-778-2542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCDRH.0066843207V00000X
ARE-15598207V00000X
CA17006207V00000X
DCDO034850207V00000X
FLOS17301207V00000X
GA82631207V00000X
IL036159904207V00000X
MDH0093817207V00000X
MIEMC0001799207V00000X
MN70365207V00000X
NJ25MB10437600207V00000X
OH34.015356207V00000X
MO2022038731207V00000X
TXT1204207V00000X
NY256735207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology