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NPI Code Detail

MEDICARE: JASON KELLOGG M.D. INC

MEDICARE: JASON KELLOGG M.D. INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RG0300XGeriatric Medicine (Internal Medicine) Physician
22084N0400XNeurology Physician
3213ES0103XFoot & Ankle Surgery Podiatrist
4335E00000XProsthetic/Orthotic Supplier
52084P0800XPsychiatry Physician

General Provider Information

NPI Number : 1235391624
Entity Type Code : Organization
Provider Name (Legal Business Name) : JASON KELLOGG M.D. INC
Provider Business Mailing Address
First Line : 1048 IRVINE AVE # 1056
Second Line :
City : NEWPORT BEACH
State : CA
Zip : 92660-4602
Country : US
Telephone Number : 949-340-2111
Fax Number : 714-495-4105
Provider Business Practice Location Address
First Line : 123 TURQUOISE AVE
Second Line :
City : NEWPORT BEACH
State : CA
Zip : 92662-1036
Country : US
Telephone Number : 949-340-2111
Fax Number : 714-495-4105
Authorized Official
Title or Position : OWNER
Name : DR. JASON P KELLOGG
Credential : M.D.
Telephone Number : 949-955-2101
Provider Enumeration Date : 06/27/2008
Last Update Date : 07/14/2022

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