Provider Demographics
NPI:1104886142
Name:KUMAR, PARMOD (MD)
Entity type:Individual
Prefix:
First Name:PARMOD
Middle Name:
Last Name:KUMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 N CHERRY ST.
Mailing Address - Street 2:PMB # 552
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-2233
Mailing Address - Country:US
Mailing Address - Phone:559-781-6655
Mailing Address - Fax:559-781-7876
Practice Address - Street 1:583 W PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3260
Practice Address - Country:US
Practice Address - Phone:559-781-6655
Practice Address - Fax:559-781-7876
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46046174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1104886142OtherNPI
CA00A460460Medicaid
CA00A460460Medicaid
CA1104886142OtherNPI