Provider Demographics
NPI:1124046172
Name:KUMAR, LAJU A (MD)
Entity Type:Individual
Prefix:DR
First Name:LAJU
Middle Name:A
Last Name:KUMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2694 HERITAGE AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-8603
Mailing Address - Country:US
Mailing Address - Phone:559-851-5258
Mailing Address - Fax:
Practice Address - Street 1:2694 HERITAGE AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-8603
Practice Address - Country:US
Practice Address - Phone:559-851-5258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC132733207Q00000X
GA065273207Q00000X
TN37976207Q00000X
OK29668207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05623256Medicaid
MS080003964Medicare PIN
MSH79100Medicare UPIN