Healthcare Provider Details

I. General information

NPI: 1750216412
Provider Name (Legal Business Name): SUHANI JAYADEV
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25395 MADISON AVE STE 103
MURRIETA CA
92562-9003
US

IV. Provider business mailing address

4623 DA VINCI ST
SAN DIEGO CA
92130-2729
US

V. Phone/Fax

Practice location:
  • Phone: 951-696-5660
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113050
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: