Healthcare Provider Details

I. General information

NPI: 1184310153
Provider Name (Legal Business Name): SOUMAJIT KUNDU DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 MEDICAL CENTER CT
CHULA VISTA CA
91911-6617
US

IV. Provider business mailing address

PO BOX 2249
LA MESA CA
91943-2249
US

V. Phone/Fax

Practice location:
  • Phone: 619-502-5800
  • Fax:
Mailing address:
  • Phone: 619-461-1920
  • Fax: 619-461-1919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A25170
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: