Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 108161 | MN |
N | 208200000X | Surgeon | 57.018214 | OH |
N | 208600000X | Surgeon | 57.018214 | OH |
NPI | 1003112657 |
---|---|
Provider Name | Dr. Vijay Kiran Jayanti |
First Address | Bemidji, MN 56601-5103 |
Second Address | Bemidji, MN 56601-5103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2011 |
Last Update Date | 25/01/2022 |