Healthcare Provider Details

I. General information

NPI: 1780612846
Provider Name (Legal Business Name): RAVI I KUMAR MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 VAN DORSTEN AVE
CORCORAN CA
93212-2321
US

IV. Provider business mailing address

1001 VAN DORSTEN AVE
CORCORAN CA
93212-2321
US

V. Phone/Fax

Practice location:
  • Phone: 559-992-2337
  • Fax: 559-992-3269
Mailing address:
  • Phone: 559-992-2337
  • Fax: 559-992-3269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License NumberRHM 53951 F
License Number StateCA

VIII. Authorized Official

Name: DR. RAVI I KUMAR
Title or Position: DIRECTOR
Credential: MD
Phone: 559-992-2337