Healthcare Provider Details

I. General information

NPI: 1407723406
Provider Name (Legal Business Name): NIKLESH KUMAR MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2025
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7412 BARONNEL LN
SACRAMENTO CA
95828-4604
US

IV. Provider business mailing address

7412 BARONNEL LN
SACRAMENTO CA
95828-4604
US

V. Phone/Fax

Practice location:
  • Phone: 916-661-8611
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: NIKLESH AHNEEL KUMAR
Title or Position: OWNER
Credential:
Phone: 916-661-8611