Healthcare Provider Details

I. General information

NPI: 1508967548
Provider Name (Legal Business Name): PRADEEP J KUMAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9353 IMPERIAL HIGHWAY
DOWNEY CA
90242-3456
US

IV. Provider business mailing address

393 E WALNUT ST GROUP & PROVIDER ENROLLMENT UNIT
PASADENA CA
91188-6129
US

V. Phone/Fax

Practice location:
  • Phone: 562-657-4110
  • Fax: 562-657-4177
Mailing address:
  • Phone: 888-505-0043
  • Fax: 626-405-6768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG73865
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: