Healthcare Provider Details

I. General information

NPI: 1205269065
Provider Name (Legal Business Name): JAY KUMAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2013
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 HOLBROOK RD STE 2200
FORT MILL SC
29715-9675
US

IV. Provider business mailing address

1935 HOLBROOK RD STE 2200
FORT MILL SC
29715-9675
US

V. Phone/Fax

Practice location:
  • Phone: 803-650-4281
  • Fax:
Mailing address:
  • Phone: 803-650-4281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number95698
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: