Provider Demographics
NPI:1013200583
Name:ARKIN, JASON DANIEL
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:DANIEL
Last Name:ARKIN
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 1:1000 QUAIL ST
Mailing Address - Street 2:STE 185
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2766
Mailing Address - Country:US
Mailing Address - Phone:415-641-8000
Mailing Address - Fax:415-641-8002
Practice Address - Street 1:107 S FAIR OAKS AVE STE 325
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2085
Practice Address - Country:US
Practice Address - Phone:510-414-7366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 26849103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical