Healthcare Provider Details

I. General information

NPI: 1730452806
Provider Name (Legal Business Name): RAHI KUMAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2012
Last Update Date: 03/19/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S SAN MATEO DR
SAN MATEO CA
94401-3805
US

IV. Provider business mailing address

500 REDWOOD BLVD STE 300
NOVATO CA
94947-6921
US

V. Phone/Fax

Practice location:
  • Phone: 650-696-4515
  • Fax: 650-696-4626
Mailing address:
  • Phone: 415-884-3474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number0000
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA123398
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: