=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215246954
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KUSUM STOKES MD A MEDICAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2010
-----------------------------------------------------
Last Update Date | 04/23/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3200 WALFORD AVE
-----------------------------------------------------
City | EUREKA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95503-4828
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-443-4869
-----------------------------------------------------
Fax | 707-442-5095
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 6630
-----------------------------------------------------
City | EUREKA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95502-6630
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-443-4869
-----------------------------------------------------
Fax | 707-442-5095
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. KUSUM G STOKES
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 707-443-4869
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | A34267
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------