Provider Demographics
NPI:1154018869
Name:JKMENONLLC
Entity type:Organization
Organization Name:JKMENONLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:DR
Authorized Official - First Name:JYOTSNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOCHIYIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-240-8725
Mailing Address - Street 1:3300 NE 188TH ST APT 812
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3377
Mailing Address - Country:US
Mailing Address - Phone:954-240-8725
Mailing Address - Fax:
Practice Address - Street 1:7636 NE 4TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33138-5285
Practice Address - Country:US
Practice Address - Phone:904-315-4955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty