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General NPI Number Information
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NPI Number | 1073283602
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Entity Type | Individual
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Provider Name | SRUTHI JAYAKUMAR DDS
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Gender | Female
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Dates
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Enumeration Date | 09/15/2021
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Last Update Date | 01/19/2025
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Provider Practice Location Address
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Address Line | 3705 BEACON AVE STE 101
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City | FREMONT
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State | CA
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Zip | 94538-1467
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Country | US
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Telephone | 510-794-9122
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Fax |
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Provider Business Mailing Address
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Address Line | 526 GLENBRIAR CIR
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City | TRACY
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State | CA
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Zip | 95377-7010
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Country | US
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Telephone | 650-787-5687
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901601897
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 106960
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License Number State | CA
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