Provider Demographics
NPI:1194957589
Name:KASS, JASON (MDPHD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:KASS
Suffix:
Gender:M
Credentials:MDPHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 HARRISON AVE
Mailing Address - Street 2:DOB 503
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2371
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:830 HARRISON AVE
Practice Address - Street 2:STE 1400
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-6504
Practice Address - Country:US
Practice Address - Phone:617-638-8124
Practice Address - Fax:617-638-6424
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT195896207Y00000X
NY273375207Y00000X
MA263693207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology