Provider Demographics
NPI:1275044935
Name:KUMAR, AISHWARYA SURYA (DDS)
Entity Type:Individual
Prefix:DR
First Name:AISHWARYA
Middle Name:SURYA
Last Name:KUMAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 LLANO DE LOS ROBLES AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95136-4880
Mailing Address - Country:US
Mailing Address - Phone:520-254-3181
Mailing Address - Fax:
Practice Address - Street 1:6529 CROWN BLVD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95120-2905
Practice Address - Country:US
Practice Address - Phone:408-997-1251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-20
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1016571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice