Healthcare Provider Details

I. General information

NPI: 1962712729
Provider Name (Legal Business Name): NISHCHAL KUMAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2010
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 EL CAMINO REAL STE 209
TUSTIN CA
92780-3656
US

IV. Provider business mailing address

3972 BARRANCA PKWY # J135
IRVINE CA
92606-1204
US

V. Phone/Fax

Practice location:
  • Phone: 714-533-1234
  • Fax: 714-991-1782
Mailing address:
  • Phone: 714-533-1234
  • Fax: 714-991-1782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA128234
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: