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General NPI Number Information
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NPI Number | 1730709023
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Entity Type | Organization
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Legal Business Name | JAY ENTERPRISE LLC
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Dates
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Enumeration Date | 04/16/2020
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Last Update Date | 04/16/2020
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Provider Practice Location Address
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Address Line | 8315 W 119TH TER
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City | OVERLAND PARK
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State | KS
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Zip | 66213-1225
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Country | US
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Telephone | 913-205-4305
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Fax |
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Provider Business Mailing Address
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Address Line | 8315 W 119TH TER
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City | OVERLAND PARK
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State | KS
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Zip | 66213-1225
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Country | US
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Telephone | 913-205-4305
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. GAUTAM JAYASWAL
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Credential | MD
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Telephone | 913-205-4305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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