Healthcare Provider Details

I. General information

NPI: 1679488258
Provider Name (Legal Business Name): JASON KURIAKOSE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3602 RIVERSIDE PLAZA DR STE 101
RIVERSIDE CA
92506-2726
US

IV. Provider business mailing address

2131 COLLETT AVE UNIT 208
CORONA CA
92879-8630
US

V. Phone/Fax

Practice location:
  • Phone: 951-228-9576
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113732
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: