Healthcare Provider Details

I. General information

NPI: 1093707143
Provider Name (Legal Business Name): RAJ KUMAR MSC MBBS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 03/27/2022
Certification Date: 03/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 C STREET SW
WASHINGTON DC
20202-9517
US

IV. Provider business mailing address

PO BOX 771
MANTECA CA
95336-1133
US

V. Phone/Fax

Practice location:
  • Phone: 202-260-0428
  • Fax: 202-401-2901
Mailing address:
  • Phone: 812-205-5470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA04339
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number52699
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: