Provider Demographics
NPI:1093707143
Name:KUMAR, RAJ (MSC MBBS PA-C)
Entity Type:Individual
Prefix:MR
First Name:RAJ
Middle Name:
Last Name:KUMAR
Suffix:
Gender:M
Credentials:MSC MBBS PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 771
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-1133
Mailing Address - Country:US
Mailing Address - Phone:812-205-5470
Mailing Address - Fax:
Practice Address - Street 1:330 C STREET SW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20202-9517
Practice Address - Country:US
Practice Address - Phone:202-260-0428
Practice Address - Fax:202-401-2901
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2022-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04339363A00000X
CA363AM0700X
CA52699363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical