Healthcare Provider Details

I. General information

NPI: 1841999539
Provider Name (Legal Business Name): KARAN TULSHI JIVA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 NE MALL BLVD
HURST TX
76053-4653
US

IV. Provider business mailing address

808 NE MALL BLVD
HURST TX
76053-4653
US

V. Phone/Fax

Practice location:
  • Phone: 817-595-9675
  • Fax:
Mailing address:
  • Phone: 817-595-9675
  • 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 State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number39792
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: