Provider Demographics
NPI:1811915812
Name:KERI, JASON SHAMMUEL (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:SHAMMUEL
Last Name:KERI
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 1:2810 CAMINO DEL RIO S
Mailing Address - Street 2:STE 102
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3818
Mailing Address - Country:US
Mailing Address - Phone:619-299-4374
Mailing Address - Fax:866-611-4220
Practice Address - Street 1:2810 CAMINO DEL RIO S
Practice Address - Street 2:STE 102
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3818
Practice Address - Country:US
Practice Address - Phone:619-299-4374
Practice Address - Fax:866-611-4220
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA820172084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A920170Medicaid
151962Medicare UPIN
CAA82017Medicare PIN