Provider Demographics
NPI:1679001564
Name:HASSAN, MOHAMMED KAMRUL (DPM)
Entity type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:KAMRUL
Last Name:HASSAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15141 WHITTIER BLVD STE 330
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-2168
Mailing Address - Country:US
Mailing Address - Phone:562-399-5252
Mailing Address - Fax:562-399-5253
Practice Address - Street 1:15141 WHITTIER BLVD STE 330
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-2168
Practice Address - Country:US
Practice Address - Phone:562-399-5252
Practice Address - Fax:562-399-5253
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA5669213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program