Provider Demographics
NPI:1952331530
Name:KELLOGG, JASON P (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:P
Last Name:KELLOGG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:17782 COWAN, STE A
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614
Mailing Address - Country:US
Mailing Address - Phone:949-722-7118
Mailing Address - Fax:949-579-9102
Practice Address - Street 1:17782 COWAN
Practice Address - Street 2:SUITE A
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6030
Practice Address - Country:US
Practice Address - Phone:949-722-7118
Practice Address - Fax:949-722-7119
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA661302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH29441Medicare UPIN