Healthcare Provider Details

I. General information

NPI: 1427160324
Provider Name (Legal Business Name): BANGARUSWAMY V KUMAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7172 MAGNOLIA AVE
RIVERSIDE CA
92504-3804
US

IV. Provider business mailing address

PO BOX 844658
DALLAS TX
75284-4658
US

V. Phone/Fax

Practice location:
  • Phone: 951-788-2224
  • Fax:
Mailing address:
  • Phone: 254-724-2111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberK6633
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: