Healthcare Provider Details

I. General information

NPI: 1407114390
Provider Name (Legal Business Name): JENNIFER S KUMASAKI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2012
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LAKE DR E
CHANHASSEN MN
55317-9302
US

IV. Provider business mailing address

300 LAKE DR E
CHANHASSEN MN
55317-9302
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-4300
  • Fax: 952-993-4320
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number17112
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number62052
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number62052
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: