Provider Demographics
NPI:1821969130
Name:SANGRAIT, JASON JAMES
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:JAMES
Last Name:SANGRAIT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 DOUGLAS DR N APT 9
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55422-2443
Mailing Address - Country:US
Mailing Address - Phone:763-400-9030
Mailing Address - Fax:
Practice Address - Street 1:3330 DOUGLAS DR N APT 9
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55422-2443
Practice Address - Country:US
Practice Address - Phone:763-400-9030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program