Individual provider Active NPI

Jeremy Elliott Kaslow, M.D.

  • Allergy & Immunology (Internal Medicine) Physician
  • Santa Ana, CA
National Provider Identifier
1144305574
Registry record updated Aug 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy & Immunology (Internal Medicine) PhysicianTaxonomy code 207RA0201X
License
G55911 Issued in CA
Practice address
720 N Tustin Ave Ste 202
Santa Ana, CA 92705-3606
Phone
(714) 565-1032
Fax
(714) 565-1035
NPI assigned
Oct 25, 2006
Last updated
Aug 6, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 6, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical & Laboratory Immunology (Allergy & Immunology) Physician 207KI0005X G55911 CA
Pediatric Allergy/Immunology Physician 2080P0201X G55911 CA
Allergy & Immunology (Internal Medicine) Physician 207RA0201X G55911 CA Primary

Addresses

Primary practice location

720 N Tustin Ave Ste 202
Santa Ana, CA 92705-3606

Mailing address

720 N Tustin Ave Ste 202
Santa Ana, CA 92705-3606
Phone (714) 565-1032

Other identifiers 3

IdentifierTypeStateIssuer
G55911OtherCACALIFORNIA STATE LICENSE
33-0428376OtherCAFEIN
82-0877333OtherCAFEIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.
Opted out of Medicare
Yes, effective Oct 25, 2017 through Oct 25, 2027

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
55911CAMDPharmacist
G55911CAMDPediatric Allergy/Immunology Physician

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722902400000",
    "number": "1144305574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 N TUSTIN AVE STE 202",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927053606",
            "telephone_number": "714-565-1032",
            "fax_number": "714-565-1035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 N TUSTIN AVE STE 202",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927053606",
            "telephone_number": "714-565-1032",
            "fax_number": "714-565-1035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KASLOW",
        "first_name": "JEREMY",
        "middle_name": "ELLIOTT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-25",
        "last_updated": "2024-08-06",
        "certification_date": "2024-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207KI0005X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology, Clinical & Laboratory Immunology",
            "state": "CA",
            "license": "G55911",
            "primary": false
        },
        {
            "code": "2080P0201X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Allergy/Immunology",
            "state": "CA",
            "license": "G55911",
            "primary": false
        },
        {
            "code": "207RA0201X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Allergy & Immunology",
            "state": "CA",
            "license": "G55911",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA STATE LICENSE",
            "identifier": "G55911",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEIN",
            "identifier": "33-0428376",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEIN",
            "identifier": "82-0877333",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Ana, CA

Sources for this page

Verify at the official NPI Registry.