MEDICARE: YAZDAAN JUMA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	64780	MN
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1649632324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YAZDAAN JUMA M.D.

Provider Business Mailing Address
First Line	:	1495 COUNTY ROAD 101 N
Second Line	:
City	:	PLYMOUTH
State	:	MN
Zip	:	55447-3078
Country	:	US
Telephone Number	:	763-504-6500
Fax Number	:

Provider Business Practice Location Address
First Line	:	1495 COUNTY ROAD 101 N
Second Line	:
City	:	PLYMOUTH
State	:	MN
Zip	:	55447-3078
Country	:	US
Telephone Number	:	763-504-6500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2016
Last Update Date	:	03/24/2021

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