Individual
JASON C KANTOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1300 W 7TH ST, SAN PEDRO, CA 90732-3505
(310) 832-3311
Mailing address
100 OCEANGATE, SUITE 1000, LONG BEACH, CA 90802-4312
(562) 590-7400
(562) 590-7452
Taxonomy
Speciality
Code
Description
License number
State
2085N0904X
Nuclear Radiology Physician
G40284
CA
2085R0202X
Diagnostic Radiology Physician
Primary
G40284
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G402840
BLUE SHIELD
CA
05
—
00G402840
—
CA
Enumeration date
11/18/2005
Last updated
05/08/2014
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