Provider Demographics
NPI:1639499247
Name:THIYANARATNAM, JAYANTHA (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYANTHA
Middle Name:
Last Name:THIYANARATNAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 EL PASEO ST APT 1403
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-3213
Mailing Address - Country:US
Mailing Address - Phone:661-878-0438
Mailing Address - Fax:
Practice Address - Street 1:1709 DRYDEN RD # 570
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2400
Practice Address - Country:US
Practice Address - Phone:713-798-0190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-04
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10036783207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine