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General NPI Number Information
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NPI Number | 1568639466
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Entity Type | Individual
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Provider Name | SANTHOSH KUMAR BANGALORE VASANTHA KUMAR M.D
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Gender | Male
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Dates
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Enumeration Date | 05/11/2008
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 1605 CHANTILLY DR NE
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City | ATLANTA
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State | GA
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Zip | 30324-3267
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Country | US
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Telephone | 804-517-2232
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Fax | 404-778-4431
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Provider Business Mailing Address
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Address Line | 1605 CHANTILLY DR NE
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City | ATLANTA
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State | GA
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Zip | 30324-3267
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Country | US
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Telephone | 804-517-2232
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Fax | 404-778-4431
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2080P0201X
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Taxonomy Name | Pediatric Allergy/Immunology Physician
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License Number | 0101247688
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 103011
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License Number State | GA
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