Active NPI
Samy Hussan, DDS
- Dentist
- Chicago, IL
National Provider Identifier
1043524911
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019028437
- Practice address
- 6560 W Fullerton Ave
# O
Chicago, IL 60707 - Phone
- (773) 385-6700
- Fax
- (773) 385-6767
- NPI assigned
- Aug 3, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019028437 | IL | Primary |
| Dentist | 122300000X | 59305 | CA |
Addresses
Primary practice location
6560 W Fullerton Ave
# O
Chicago, IL 60707
Mailing address
430 W. Erie St
Suite 200
Chicago, IL 60610
Phone (312) 274-0308
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 59305 | CA | MD | Dentist |
| 019028437 | IL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1280793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1280793600000",
"number": "1043524911",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "430 W. ERIE ST",
"address_2": "SUITE 200",
"city": "CHICAGO",
"state": "IL",
"postal_code": "60610",
"telephone_number": "312-274-0308",
"fax_number": "312-944-9499"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6560 W FULLERTON AVE",
"address_2": "# O",
"city": "CHICAGO",
"state": "IL",
"postal_code": "60707",
"telephone_number": "773-385-6700",
"fax_number": "773-385-6767"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HUSSAN",
"first_name": "SAMY",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-08-03",
"last_updated": "2010-08-03",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019028437",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "59305",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.