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General NPI Number Information
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NPI Number | 1770133308
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Entity Type | Individual
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Provider Name | MINI KRISHNAKUMAR DDS
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Gender | Female
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Dates
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Enumeration Date | 09/16/2019
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Last Update Date | 09/16/2019
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Provider Practice Location Address
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Address Line | 921 S MAIN ST
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City | SALINAS
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State | CA
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Zip | 93901-2435
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Country | US
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Telephone | 831-998-9427
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Fax |
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Provider Business Mailing Address
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Address Line | 3745 JASMINE CIR
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City | SAN JOSE
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State | CA
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Zip | 95135-2377
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Country | US
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Telephone | 408-550-5751
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 104426
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License Number State | CA
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