Healthcare Provider Details

I. General information

NPI: 1689638587
Provider Name (Legal Business Name): VIJAY KUMAR MD,FCCP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 09/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1174 AMAZON WAY
SIMI VALLEY CA
93065-3156
US

IV. Provider business mailing address

1174 AMAZON WAY
SIMI VALLEY CA
93065-3156
US

V. Phone/Fax

Practice location:
  • Phone: 805-527-5878
  • Fax: 805-527-0114
Mailing address:
  • Phone: 805-527-5878
  • Fax: 805-527-0114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA46673
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: