Provider Demographics
NPI:1962724187
Name:VASANTH K KUMAR M D INC
Entity type:Organization
Organization Name:VASANTH K KUMAR M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VASANTH
Authorized Official - Middle Name:KUKKALA
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:213-595-6383
Mailing Address - Street 1:5245 VISTA LEJANA LN
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-1860
Mailing Address - Country:US
Mailing Address - Phone:213-595-6383
Mailing Address - Fax:
Practice Address - Street 1:5245 VISTA LEJANA LN
Practice Address - Street 2:
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-1860
Practice Address - Country:US
Practice Address - Phone:213-595-6383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-16
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32885207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1689657496OtherNPI
CA00A328850Medicaid
CAA32885Medicare PIN
CA00A328850Medicaid