Provider Demographics
NPI:1932158128
Name:VENKATESAN, JAYANTI (MD)
Entity type:Individual
Prefix:
First Name:JAYANTI
Middle Name:
Last Name:VENKATESAN
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:PO BOX 58538
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-8538
Mailing Address - Country:US
Mailing Address - Phone:281-724-8296
Mailing Address - Fax:281-724-1858
Practice Address - Street 1:600 N KOBAYASHI STE 312
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4841
Practice Address - Country:US
Practice Address - Phone:281-724-8296
Practice Address - Fax:281-724-1858
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8158207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84998GOtherBCBS #
TX85357JMedicare PIN
TXB82471Medicare UPIN