Provider Demographics
NPI:1528352051
Name:GHASSEMI, SOGAND B (MD)
Entity type:Individual
Prefix:
First Name:SOGAND
Middle Name:B
Last Name:GHASSEMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 94TH AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-1992
Mailing Address - Country:US
Mailing Address - Phone:763-762-8810
Mailing Address - Fax:763-315-6685
Practice Address - Street 1:5500 94TH AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-1992
Practice Address - Country:US
Practice Address - Phone:763-762-8810
Practice Address - Fax:763-315-6685
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN565532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNENROLLEDMedicaid
MNH400121584Medicare PIN