Provider Demographics
NPI:1295838746
Name:KUMAR, PRADEEP (MD FACC FSCAI)
Entity Type:Individual
Prefix:
First Name:PRADEEP
Middle Name:
Last Name:KUMAR
Suffix:
Gender:M
Credentials:MD FACC FSCAI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 MOWRY AVE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1722
Mailing Address - Country:US
Mailing Address - Phone:510-790-9300
Mailing Address - Fax:510-790-9301
Practice Address - Street 1:1900 MOWRY AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1722
Practice Address - Country:US
Practice Address - Phone:510-790-9300
Practice Address - Fax:510-790-9301
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62416207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A624160Medicaid
H13029Medicare UPIN
CA00A624160Medicaid