Healthcare Provider Details

I. General information

NPI: 1912353277
Provider Name (Legal Business Name): JAYKUMAR UNNI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2016
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 NE MOTHER JOSEPH PL
VANCOUVER WA
98664-3200
US

IV. Provider business mailing address

1941 EAST RD SUITE 3236
HOUSTON TX
77054-6010
US

V. Phone/Fax

Practice location:
  • Phone: 360-256-2000
  • Fax: 360-514-2458
Mailing address:
  • Phone: 713-486-2570
  • Fax: 713-486-2565

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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD61587327
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberS3606
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number319563
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: