Provider Demographics
NPI:1255699260
Name:KWASA, SASSEN S (MD)
Entity type:Individual
Prefix:
First Name:SASSEN
Middle Name:S
Last Name:KWASA
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 19344
Mailing Address - Street 2:
Mailing Address - City:NAIROBI
Mailing Address - State:NAIROBI
Mailing Address - Zip Code:00200
Mailing Address - Country:KE
Mailing Address - Phone:402-203-4153
Mailing Address - Fax:
Practice Address - Street 1:1400 W 22ND ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105
Practice Address - Country:US
Practice Address - Phone:605-357-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD9510208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist