Provider Demographics
NPI:1588918270
Name:KASS, JOHN CLAUDE D (LCSA)
Entity type:Individual
Prefix:MR
First Name:JOHN CLAUDE
Middle Name:D
Last Name:KASS
Suffix:
Gender:M
Credentials:LCSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:704 CLARK CT NE APT 204
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-4708
Mailing Address - Country:US
Mailing Address - Phone:571-577-0361
Mailing Address - Fax:571-442-8286
Practice Address - Street 1:704 CLARK CT NE APT 204
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-4708
Practice Address - Country:US
Practice Address - Phone:571-577-0361
Practice Address - Fax:571-442-8286
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-01
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCSA0078363AS0400X
246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3634OtherNATIONAL SURGICAL ASSISTANT ASSOCIATION