Healthcare Provider Details

I. General information

NPI: 1235076654
Provider Name (Legal Business Name): JYOTSNA KRISHNAKUMAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 N WINCHESTER BLVD
SANTA CLARA CA
95050-6325
US

IV. Provider business mailing address

516 CLIFTON AVE
SAN JOSE CA
95128-2315
US

V. Phone/Fax

Practice location:
  • Phone: 408-248-3736
  • Fax:
Mailing address:
  • Phone: 508-873-2353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP39736
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: