Healthcare Provider Details

I. General information

NPI: 1134126329
Provider Name (Legal Business Name): SRINIVASA K ASHOKKUMAR M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 VETERANS BLVD
REDWOOD CITY CA
94063-2037
US

IV. Provider business mailing address

355 ABBOTT ST STE 100
SALINAS CA
93901-4484
US

V. Phone/Fax

Practice location:
  • Phone: 650-299-2015
  • Fax:
Mailing address:
  • Phone: 831-649-1000
  • Fax: 831-649-4962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC42227
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: