Healthcare Provider Details

I. General information

NPI: 1235513102
Provider Name (Legal Business Name): GAURAV KUMAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2015
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 N CALIFORNIA ST
STOCKTON CA
95202-1515
US

IV. Provider business mailing address

1414 N CALIFORNIA ST
STOCKTON CA
95202-1515
US

V. Phone/Fax

Practice location:
  • Phone: 209-468-6820
  • 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 Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA151187
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: