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General NPI Number Information
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NPI Number | 1700713195
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Entity Type | Organization
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Legal Business Name | JSK PREMIER MSO INC
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Dates
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Enumeration Date | 05/07/2026
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Last Update Date | 05/07/2026
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Provider Practice Location Address
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Address Line | 2720 N HARBOR BLVD STE 350
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City | FULLERTON
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State | CA
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Zip | 92835-2602
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Country | US
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Telephone | 714-529-8923
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Fax |
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Provider Business Mailing Address
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Address Line | 17 BARLETT PL
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City | TUSTIN
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State | CA
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Zip | 92782-3742
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Country | US
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Telephone | 909-631-8521
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ASHISH BHAVSAR
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Credential | MD
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Telephone | 909-631-8521
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084H0002X
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Taxonomy Name | Hospice and Palliative Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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