Healthcare Provider Details

I. General information

NPI: 1992403349
Provider Name (Legal Business Name): ASHWANI KUMAR MD A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2023
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 CHURN CREEK RD
REDDING CA
96002-2718
US

IV. Provider business mailing address

3335 PLACER ST # 202
REDDING CA
96001-2364
US

V. Phone/Fax

Practice location:
  • Phone: 702-453-3799
  • Fax: 702-453-5741
Mailing address:
  • Phone: 702-453-3799
  • Fax: 702-453-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ASHWANI KUMAR
Title or Position: SOLE OWNER
Credential: M.D.
Phone: 530-356-6653