Provider Demographics
NPI:1740303411
Name:KUMAR, JAYA (MD)
Entity type:Individual
Prefix:
First Name:JAYA
Middle Name:
Last Name:KUMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 W. MOCKINGBIRD LANE
Mailing Address - Street 2:SUITE 240E
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4971
Mailing Address - Country:US
Mailing Address - Phone:214-638-6600
Mailing Address - Fax:214-638-6618
Practice Address - Street 1:1341 W. MOCKINGBIRD LANE
Practice Address - Street 2:SUITE 240E
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4971
Practice Address - Country:US
Practice Address - Phone:214-638-6600
Practice Address - Fax:214-638-6618
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2156207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2019788-01Medicaid
TX2019788-01Medicaid