Provider Demographics
NPI:1003171752
Name:KUMAR, JASPAL K
Entity Type:Individual
Prefix:
First Name:JASPAL
Middle Name:K
Last Name:KUMAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1883 AGNEW RD
Mailing Address - Street 2:#229
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054-1789
Mailing Address - Country:US
Mailing Address - Phone:408-986-1679
Mailing Address - Fax:
Practice Address - Street 1:1600 SARATOGA AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-5101
Practice Address - Country:US
Practice Address - Phone:408-871-7984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61026183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist