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NPI Code Detail

MEDICARE: SOPHANA JAYAKUMAR MDS, DDS

MEDICARE: SOPHANA JAYAKUMAR MDS, DDS
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
1122300000XDentist15323MN

General Provider Information

NPI Number : 1760364111
Entity Type Code : Individual
Provider Name (Legal Business Name) : SOPHANA JAYAKUMAR MDS, DDS
Provider Business Mailing Address
First Line : 19984 62ND PL
Second Line :
City : CORCORAN
State : MN
Zip : 55340
Country : US
Telephone Number : 612-986-7544
Fax Number :
Provider Business Practice Location Address
First Line : 11237 FOLEY BLVD NW
Second Line :
City : COON RAPIDS
State : MN
Zip : 55448-3389
Country : US
Telephone Number : 763-757-1234
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2025
Last Update Date : 07/24/2025

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