Provider Demographics
NPI:1598742710
Name:BERRY, JASON CHRISTOPHER (DO)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:CHRISTOPHER
Last Name:BERRY
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:751 S WEIR CANYON RD
Mailing Address - Street 2:SUITE 167
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-1962
Mailing Address - Country:US
Mailing Address - Phone:714-974-0611
Mailing Address - Fax:714-221-2345
Practice Address - Street 1:751 S WEIR CANYON RD
Practice Address - Street 2:SUITE 167
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92808-1962
Practice Address - Country:US
Practice Address - Phone:714-974-0611
Practice Address - Fax:714-221-2345
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A7047207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG95843Medicare UPIN
CA20A7047Medicare ID - Type UnspecifiedPROVIDER ID