MEDICARE: KIPLING JAMES CUMMINS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	95154662	CA

General Provider Information

NPI Number	:	1295616670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIPLING JAMES CUMMINS

Provider Business Mailing Address
First Line	:	1192 CHAMPAGNE LN
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95132-3018
Country	:	US
Telephone Number	:	269-589-9839
Fax Number	:

Provider Business Practice Location Address
First Line	:	1192 CHAMPAGNE LN
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95132-3018
Country	:	US
Telephone Number	:	269-589-9839
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2025
Last Update Date	:	09/10/2025

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