Provider Demographics
NPI:1003859414
Name:KUMAR, RAVI I (MD,)
Entity Type:Individual
Prefix:DR
First Name:RAVI
Middle Name:I
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 1:1101 N. CHERRY TREET
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-0000
Mailing Address - Country:US
Mailing Address - Phone:559-686-9097
Mailing Address - Fax:559-686-4750
Practice Address - Street 1:1101 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-2231
Practice Address - Country:US
Practice Address - Phone:559-686-9097
Practice Address - Fax:559-686-4750
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA067010207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A670100Medicaid
CA00A670100Medicaid