Healthcare Provider Details

I. General information

NPI: 1114160603
Provider Name (Legal Business Name): SAURABH KUMAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 08/22/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19330 JESSE LN STE 100
RIVERSIDE CA
92508-5077
US

IV. Provider business mailing address

19330 JESSE LN STE 100
RIVERSIDE CA
92508-5077
US

V. Phone/Fax

Practice location:
  • Phone: 951-827-7793
  • Fax:
Mailing address:
  • Phone: 951-827-7793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2013040208
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC176908
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: