Healthcare Provider Details

I. General information

NPI: 1275678294
Provider Name (Legal Business Name): JASMINE TAN-KIM M.D., M.A.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JASMINE S TAN M.D.

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR MAIL CODE 8433
SAN DIEGO CA
92103-8433
US

IV. Provider business mailing address

3250 FORDHAM ST
SAN DIEGO CA
92110-5339
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-6922
  • Fax: 619-543-5767
Mailing address:
  • Phone: 619-221-0350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA92871
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberA92871
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: