Provider Demographics
NPI:1033750500
Name:KAN, JAZMIN (PT, DPT, CSCS)
Entity Type:Individual
Prefix:
First Name:JAZMIN
Middle Name:
Last Name:KAN
Suffix:
Gender:F
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 SANDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-5392
Mailing Address - Country:US
Mailing Address - Phone:626-376-7542
Mailing Address - Fax:
Practice Address - Street 1:25565 JERONIMO RD
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-2707
Practice Address - Country:US
Practice Address - Phone:949-627-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA296436225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist