Healthcare Provider Details

I. General information

NPI: 1053477539
Provider Name (Legal Business Name): UMESHKUMAR JAGJIVANDAS MISTRY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4470 LINCOLN AVE STE 4
CYPRESS CA
90630-6110
US

IV. Provider business mailing address

4470 LINCOLN AVE STE 4
CYPRESS CA
90630-6110
US

V. Phone/Fax

Practice location:
  • Phone: 714-952-3119
  • Fax:
Mailing address:
  • Phone: 714-952-3119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number38092
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: