Provider Demographics
NPI:1639359946
Name:KOH, JASON ROBERT (DO)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ROBERT
Last Name:KOH
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:6771 WARNER AVE UNIT 3976
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92605-7041
Mailing Address - Country:US
Mailing Address - Phone:562-595-0790
Mailing Address - Fax:562-595-0839
Practice Address - Street 1:2840 LONG BEACH BLVD STE 465
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1594
Practice Address - Country:US
Practice Address - Phone:562-595-0790
Practice Address - Fax:562-595-0839
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2024-02-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A10104208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation