Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | A110213 | CA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | A110213 | CA |
NPI | 1154583722 |
---|---|
Provider Name | Raj S Kullar |
First Address | Los Altos, CA 94022-1408 |
Second Address | Los Gatos, CA 95030-3337 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2008 |
Last Update Date | 17/02/2021 |