Provider Demographics
NPI:1417408360
Name:KUM, JASON (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:KUM
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 E 98TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46280-1973
Mailing Address - Country:US
Mailing Address - Phone:317-843-1281
Mailing Address - Fax:
Practice Address - Street 1:3003 E 98TH ST STE 200
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46280-1973
Practice Address - Country:US
Practice Address - Phone:317-426-1642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-15
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013251A1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics