Healthcare Provider Details

I. General information

NPI: 1720872971
Provider Name (Legal Business Name): JAY PATEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2025
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E 25TH ST
KANSAS CITY MO
64108-2716
US

IV. Provider business mailing address

500 LANDFAIR AVE
LOS ANGELES CA
90024-2104
US

V. Phone/Fax

Practice location:
  • Phone: 816-235-2100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2026013016
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: