MEDICARE: DR. RAJIV KUMRA M.D.

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	207QA0401X	Addiction Medicine (Family Medicine) Physician	C50114	CA
2	207QA0505X	Adult Medicine Physician	C50114	CA
3	207QS0010X	Sports Medicine (Family Medicine) Physician	C50114	CA
4	207QA0000X	Adolescent Medicine (Family Medicine) Physician	C50114	CA

General Provider Information

NPI Number	:	1750581096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAJIV KUMRA M.D.

Provider Business Mailing Address
First Line	:	2221 SUNSET BLVD STE 119
Second Line	:
City	:	ROCKLIN
State	:	CA
Zip	:	95765-4784
Country	:	US
Telephone Number	:	916-836-3006
Fax Number	:

Provider Business Practice Location Address
First Line	:	2221 SUNSET BLVD STE 119
Second Line	:
City	:	ROCKLIN
State	:	CA
Zip	:	95765-4784
Country	:	US
Telephone Number	:	916-836-3006
Fax Number	:	916-583-7220

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

Provider Enumeration Date	:	07/24/2007
Last Update Date	:	01/13/2025

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