Yassa Pac LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

YASSA PAC LLC

Practice address

624 E 9 Mile Rd
Hazel Park, MI 48030-1842

Phone

(248) 629-7497

NPI assigned

Sep 2, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Marcos Yassa

Title

PA-C

Phone

(248) 629-7497

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1599004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1608076800000",
    "number": "1962016360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 366",
            "city": "HAZEL PARK",
            "state": "MI",
            "postal_code": "480300366",
            "telephone_number": "248-629-7497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "624 E 9 MILE RD",
            "city": "HAZEL PARK",
            "state": "MI",
            "postal_code": "480301842",
            "telephone_number": "248-629-7497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YASSA PAC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-02",
        "last_updated": "2020-12-16",
        "certification_date": "2020-12-16",
        "status": "A",
        "authorized_official_last_name": "YASSA",
        "authorized_official_first_name": "MARCOS",
        "authorized_official_title_or_position": "PA-C",
        "authorized_official_telephone_number": "248-629-7497"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer D Washington, FNP
• Thomas N Weigel, D.D.S.
• Woodward Detroit CVS, L.L.C.
• Terence Woolfork
• Stacey Wray
• Basima Ykao Ykao-Daman, D.D.S.
• Li Zhi Zheng, PHARMD
• Katie Guo Zhong, PA-C

• Clinic/Center in Hazel Park, MI
• Providers in Hazel Park, MI by specialty
• Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.