Provider Demographics
NPI:1487681417
Name:KASSAN, ROB (MD)
Entity type:Individual
Prefix:DR
First Name:ROB
Middle Name:
Last Name:KASSAN
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 1:445 NUTCRACKER DR
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-7329
Mailing Address - Country:US
Mailing Address - Phone:310-650-7813
Mailing Address - Fax:
Practice Address - Street 1:1105 SE CENTENNIAL ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1343
Practice Address - Country:US
Practice Address - Phone:541-241-6471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD209589207Q00000X
CAG67840207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG67840CMedicare PIN
CAE83847Medicare UPIN