Healthcare Provider Details

I. General information

NPI: 1659339687
Provider Name (Legal Business Name): PIYUSH (PHIL) KUMAR, MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 GARDEN VIEW CT SUITE 102
ENCINITAS CA
92024-2464
US

IV. Provider business mailing address

700 GARDEN VIEW CT SUITE 102
ENCINITAS CA
92024-2464
US

V. Phone/Fax

Practice location:
  • Phone: 760-436-8881
  • Fax: 760-436-1022
Mailing address:
  • Phone: 760-436-8881
  • Fax: 760-436-1022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA44592
License Number StateCA

VIII. Authorized Official

Name: DR. PIYUSH KUMAR
Title or Position: PRESIDENT
Credential: MD
Phone: 760-436-8881