=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891156311
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KUMAR MANAGEMENT GROUP, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2016
-----------------------------------------------------
Last Update Date | 03/10/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 N BUFFALO DR 100
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89145-0310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-853-5681
-----------------------------------------------------
Fax | 702-675-6971
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 401 N BUFFALO DR 100
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89145-0310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-853-5681
-----------------------------------------------------
Fax | 702-675-6971
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/OWNER
-----------------------------------------------------
Name | VIJAY KUMAR KITTUSAMY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 702-853-5681
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------