Provider Demographics
NPI:1871895318
Name:KASSIM, KASSIM ABDIKADIR
Entity type:Individual
Prefix:MR
First Name:KASSIM
Middle Name:ABDIKADIR
Last Name:KASSIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3604 OREGON DR APT 2
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99517-2639
Mailing Address - Country:US
Mailing Address - Phone:907-306-1061
Mailing Address - Fax:
Practice Address - Street 1:3604 OREGON DR APT 2
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99517-2639
Practice Address - Country:US
Practice Address - Phone:907-306-1061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK950459171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor