Provider Demographics
NPI:1679528053
Name:RAVIKUMAR, JAYANTHI (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYANTHI
Middle Name:
Last Name:RAVIKUMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3356 W. BALL ROAD
Mailing Address - Street 2:SUITE 216
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804
Mailing Address - Country:US
Mailing Address - Phone:714-226-0818
Mailing Address - Fax:714-226-0202
Practice Address - Street 1:5451 LA PALMA AVE
Practice Address - Street 2:SUITE 47
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1732
Practice Address - Country:US
Practice Address - Phone:714-226-0818
Practice Address - Fax:714-226-0202
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA33094208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
A84428Medicare UPIN