Healthcare Provider Details

I. General information

NPI: 1437243102
Provider Name (Legal Business Name): JASON M. KNIGHT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 S MAIN ST
ORANGE CA
92868-3835
US

IV. Provider business mailing address

455 S MAIN ST
ORANGE CA
92868-3835
US

V. Phone/Fax

Practice location:
  • Phone: 714-532-8620
  • Fax: 714-289-4072
Mailing address:
  • Phone: 714-289-4511
  • Fax: 714-289-4788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberA70791
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: