Healthcare Provider Details

I. General information

NPI: 1477656932
Provider Name (Legal Business Name): VIKRAM RAMKUMAR KUMAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MISSION BLVD SUITE 2600
JACKSON CA
95642-2534
US

IV. Provider business mailing address

2069 VENEZIA ST
LOS BANOS CA
93635-6438
US

V. Phone/Fax

Practice location:
  • Phone: 209-257-1722
  • Fax: 209-257-1726
Mailing address:
  • Phone: 414-793-8336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA90318
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: