Provider Demographics
NPI:1972015477
Name:YASHWANTH JASTI MD PA
Entity Type:Organization
Organization Name:YASHWANTH JASTI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YASHWANTH
Authorized Official - Middle Name:
Authorized Official - Last Name:JASTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-389-0855
Mailing Address - Street 1:611 N MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-7428
Mailing Address - Country:US
Mailing Address - Phone:214-389-0855
Mailing Address - Fax:214-389-0859
Practice Address - Street 1:611 N MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-7428
Practice Address - Country:US
Practice Address - Phone:214-389-0855
Practice Address - Fax:214-389-0859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-25
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ2143207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty