Provider Demographics
NPI:1275678294
Name:TAN-KIM, JASMINE (MD, MAS)
Entity Type:Individual
Prefix:DR
First Name:JASMINE
Middle Name:
Last Name:TAN-KIM
Suffix:
Gender:F
Credentials:MD, MAS
Other - Prefix:DR
Other - First Name:JASMINE
Other - Middle Name:S
Other - Last Name:TAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3250 FORDHAM ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-5339
Mailing Address - Country:US
Mailing Address - Phone:619-221-0350
Mailing Address - Fax:
Practice Address - Street 1:200 W ARBOR DR
Practice Address - Street 2:MAIL CODE 8433
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-8433
Practice Address - Country:US
Practice Address - Phone:619-543-6922
Practice Address - Fax:619-543-5767
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92871207VF0040X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology