Provider Demographics
NPI:1336370162
Name:SO, JASON JIMMY (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:JIMMY
Last Name:SO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 CLAY EDWARDS DR STE 200A
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3277
Mailing Address - Country:US
Mailing Address - Phone:816-968-9320
Mailing Address - Fax:
Practice Address - Street 1:2750 CLAY EDWARDS DR
Practice Address - Street 2:STE 200A
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3237
Practice Address - Country:US
Practice Address - Phone:816-968-9320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009011011207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine