Healthcare Provider Details

I. General information

NPI: 1548376783
Provider Name (Legal Business Name): SARASA KUMAR M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 02/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13768 ROSWELL AVE SUITE 205
CHINO CA
91710-1401
US

IV. Provider business mailing address

13768 ROSWELL AVE SUITE 205
CHINO CA
91710-1401
US

V. Phone/Fax

Practice location:
  • Phone: 909-590-7356
  • Fax: 909-548-6871
Mailing address:
  • Phone: 909-590-7356
  • Fax: 909-548-6871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA49540
License Number StateCA

VIII. Authorized Official

Name: SARASA KUMAR
Title or Position: BUSINESS OWNER
Credential: M.D.
Phone: 909-590-7356