Healthcare Provider Details

I. General information

NPI: 1366020596
Provider Name (Legal Business Name): NISHITA SAMANTH KUMAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 SANTA MONICA BLVD
SANTA MONICA CA
90404-2303
US

IV. Provider business mailing address

2121 SANTA MONICA BLVD
SANTA MONICA CA
90404-2303
US

V. Phone/Fax

Practice location:
  • Phone: 310-315-6125
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberPENDING
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA206583
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: