Healthcare Provider Details

I. General information

NPI: 1972113397
Provider Name (Legal Business Name): MR. JASON JAMES KALAW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2020
Last Update Date: 08/01/2020
Certification Date: 08/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 ALAMEDA DE LAS PULGAS
REDWOOD CITY CA
94062-2751
US

IV. Provider business mailing address

2280 W EL CAMINO REAL APT 3117
MOUNTAIN VIEW CA
94040-6231
US

V. Phone/Fax

Practice location:
  • Phone: 650-369-5811
  • Fax:
Mailing address:
  • Phone: 480-925-3262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License Number8833192
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: