Provider Demographics
NPI:1306040431
Name:KUMAR, SANJIV (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SANJIV
Middle Name:
Last Name:KUMAR
Suffix:
Gender:M
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 WEST BALL ROAD
Mailing Address - Street 2:APT#58
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804
Mailing Address - Country:US
Mailing Address - Phone:347-307-7585
Mailing Address - Fax:
Practice Address - Street 1:2660 WEST BALL ROAD
Practice Address - Street 2:APT#58
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804
Practice Address - Country:US
Practice Address - Phone:347-307-7585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17995235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY8870233Medicare ID - Type UnspecifiedOXFORD