Healthcare Provider Details

I. General information

NPI: 1720415847
Provider Name (Legal Business Name): AP S KUMLIN B.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 POST STREET
SAN JOSE CA
95113
US

IV. Provider business mailing address

200 LAKEVIEW AVE, #3
PACIFICA CA
94044
US

V. Phone/Fax

Practice location:
  • Phone: 408-418-0303
  • Fax:
Mailing address:
  • Phone: 650-245-6144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number1389
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: