Sruthi Jayakumar, DDS – General Practice Dentistry

Key facts

NPI: 1073283602
Entity type: Individual (NPI type 1)
Primary specialty: General Practice Dentistry 1223G0001X
License: 106960 (CA)
Practice address: 3705 Beacon Ave Ste 101
Fremont, CA 94538-1467
Phone: (510) 794-9122
NPI assigned: Sep 15, 2021
Sex: Female
Sole proprietor: Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Pura Vida Smiles, PC Dentist · Jackson, MI · NPI 1740602846

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
106960	CA	MD	General Practice Dentistry
2901601897	MI	MD	General Practice Dentistry

Practice roles

Organization	Specialty	Status	New patients
Pura Vida Smiles, PC		Past since Oct 1, 2023	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
General Practice Dentistry	1223G0001X	2901601897	MI
General Practice Dentistry	1223G0001X	106960	CA	Yes

Addresses

Primary practice location

3705 Beacon Ave Ste 101
Fremont, CA 94538-1467

Mailing address

526 Glenbriar Cir
Tracy, CA 95377-7010
Phone (650) 787-5687

Other providers in Fremont, CA

All providers in Fremont, CA · General Practice Dentistry in California

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 19, 2025. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.