Provider Demographics
NPI:1972113397
Name:KALAW, JASON JAMES
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:JAMES
Last Name:KALAW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 W EL CAMINO REAL APT 3117
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-6231
Mailing Address - Country:US
Mailing Address - Phone:480-925-3262
Mailing Address - Fax:
Practice Address - Street 1:170 ALAMEDA DE LAS PULGAS
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-2751
Practice Address - Country:US
Practice Address - Phone:650-369-5811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-01
Last Update Date:2020-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8833192242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist