Healthcare Provider Details

I. General information

NPI: 1679033096
Provider Name (Legal Business Name): JYOTSNA KODURI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 N OGDEN ST STE 400
DENVER CO
80218-3670
US

IV. Provider business mailing address

4 E 113TH TER
KANSAS CITY MO
64114-5448
US

V. Phone/Fax

Practice location:
  • Phone: 303-318-1540
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number1679033096
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: