Provider Demographics
NPI:1568738375
Name:KUMAR, PRIYANKA (PT)
Entity type:Individual
Prefix:
First Name:PRIYANKA
Middle Name:
Last Name:KUMAR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 NUTMEG PL STE 111
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-2557
Mailing Address - Country:US
Mailing Address - Phone:714-979-3500
Mailing Address - Fax:714-979-9880
Practice Address - Street 1:100 UCLA MEDICAL PLZ
Practice Address - Street 2:#400
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-6970
Practice Address - Country:US
Practice Address - Phone:310-539-8800
Practice Address - Fax:310-443-0444
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38630225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist