Healthcare Provider Details

I. General information

NPI: 1902711724
Provider Name (Legal Business Name): MOHAMED JUKAKU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

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

703 MAIN ST
PATERSON NJ
07503-2621
US

IV. Provider business mailing address

12690 TROPIC DR N
JACKSONVILLE FL
32225-6227
US

V. Phone/Fax

Practice location:
  • Phone: 973-754-2431
  • Fax:
Mailing address:
  • Phone: 949-685-5701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: