Provider Demographics
NPI:1033625264
Name:KUMAR, KOMAL G (ABO)
Entity Type:Individual
Prefix:
First Name:KOMAL
Middle Name:G
Last Name:KUMAR
Suffix:
Gender:F
Credentials:ABO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 BARRANCA PKWY STE D
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-1200
Mailing Address - Country:US
Mailing Address - Phone:949-769-6464
Mailing Address - Fax:
Practice Address - Street 1:3800 BARRANCA PKWY STE D
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-1200
Practice Address - Country:US
Practice Address - Phone:949-769-6464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-26
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASL6858156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician