Provider Demographics
NPI:1437354354
Name:JEREMY E KASLOW, MD INC
Entity Type:Organization
Organization Name:JEREMY E KASLOW, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:E
Authorized Official - Last Name:KASLOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-565-1032
Mailing Address - Street 1:720 N TUSTIN AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3606
Mailing Address - Country:US
Mailing Address - Phone:714-565-1032
Mailing Address - Fax:714-565-1035
Practice Address - Street 1:720 N TUSTIN AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3606
Practice Address - Country:US
Practice Address - Phone:714-565-1032
Practice Address - Fax:714-565-1035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55911261Q00000X, 261QM2500X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Not Answered261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Not Answered261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG55911OtherSTATE LICENSURE