Provider Demographics
NPI:1225118979
Name:KIM, JASON H H (MD)
Entity Type:Individual
Prefix:
First Name:JASON H
Middle Name:H
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 SUNNY CREST DR STE 2700
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3645
Mailing Address - Country:US
Mailing Address - Phone:714-519-3545
Mailing Address - Fax:714-870-0000
Practice Address - Street 1:1950 SUNNY CREST DR STE 2700
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3645
Practice Address - Country:US
Practice Address - Phone:714-519-3545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000000A75011207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA75011OtherLICENSE
CAWA75011BMedicare PIN