Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 22427 | TX |
NPI | 1013025584 |
---|---|
Provider Name | Dr. Jayashree Kyatam |
First Address | Austin, TX 78717 |
Second Address | Austin, TX 78717-4909 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2006 |
Last Update Date | 04/02/2021 |