Healthcare Provider Details

I. General information

NPI: 1467397869
Provider Name (Legal Business Name): KUSUM BHAGWAN PUNJABI LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 STOCKTON AVE APT 328
SAN JOSE CA
95126-2837
US

IV. Provider business mailing address

130 STOCKTON AVE APT 328
SAN JOSE CA
95126-2837
US

V. Phone/Fax

Practice location:
  • Phone: 650-227-9282
  • Fax:
Mailing address:
  • Phone: 650-227-9282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number162622
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: