Provider Demographics
NPI:1144305574
Name:KASLOW, JEREMY ELLIOTT (MD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:ELLIOTT
Last Name:KASLOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 N TUSTIN AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3606
Mailing Address - Country:US
Mailing Address - Phone:714-565-1032
Mailing Address - Fax:714-565-1035
Practice Address - Street 1:720 N TUSTIN AVE STE 202
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3606
Practice Address - Country:US
Practice Address - Phone:714-565-1032
Practice Address - Fax:714-565-1035
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55911207KI0005X, 2080P0201X, 207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory Immunology
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG55911OtherCALIFORNIA STATE LICENSE
CA33-0428376OtherFEIN
CA82-0877333OtherFEIN