Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A067010 | CA |
NPI | 1003859414 |
---|---|
Provider Name | Dr. Ravi I Kumar |
First Address | Tulare, CA 93274-0000 |
Second Address | Tulare, CA 93274-2231 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 09/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A670100 | (05) | CA |
G 57670 | (02) |