Provider Demographics
NPI:1649835984
Name:KISSELL, JASON WILLIAM (DO)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:WILLIAM
Last Name:KISSELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5570 OVERLAND AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1215
Mailing Address - Country:US
Mailing Address - Phone:858-694-2895
Mailing Address - Fax:
Practice Address - Street 1:5570 OVERLAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1215
Practice Address - Country:US
Practice Address - Phone:858-694-2895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program