Provider Demographics
NPI:1093943821
Name:KOOB, JASON WYETH (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:WYETH
Last Name:KOOB
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:928 HARRISON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-1009
Mailing Address - Country:US
Mailing Address - Phone:415-926-5818
Mailing Address - Fax:844-610-6728
Practice Address - Street 1:928 HARRISON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-1009
Practice Address - Country:US
Practice Address - Phone:415-926-5818
Practice Address - Fax:844-610-6728
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2016-01-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA128794207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine