=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467165944
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KUMRA DDS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/29/2022
-----------------------------------------------------
Last Update Date | 12/29/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 125 N JACKSON AVE STE 101
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95116-1914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 669-699-8503
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1225 VIENNA DR SPC 976
-----------------------------------------------------
City | SUNNYVALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94089-1873
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 669-699-8503
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. RASHMI KUMRA
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 669-699-8503
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------