Individual
DR. JASON JOHN KOCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3955 PARKLAWN AVE, STE 120, EDINA, MN 55435-5655
(952) 831-1944
(952) 278-6947
Mailing address
3955 PARKLAWN AVE, STE 120, EDINA, MN 55435-5655
(952) 831-1944
(952) 278-6947
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
41959
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
057R8KO
BC/BS
MN
01
—
1201269
MEDICA
MN
01
—
FP9021027171
PREFERRED ONE
MN
Enumeration date
08/16/2006
Last updated
07/08/2007
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