Healthcare Provider Details

I. General information

NPI: 1336842434
Provider Name (Legal Business Name): SHILPA KUMAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E CHEVY CHASE DR STE 250
GLENDALE CA
91206-4293
US

IV. Provider business mailing address

1500 E CHEVY CHASE DR STE 250
GLENDALE CA
91206-4293
US

V. Phone/Fax

Practice location:
  • Phone: 818-246-7260
  • Fax:
Mailing address:
  • Phone: 818-246-7260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA197315
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: