Provider Demographics
NPI:1356304109
Name:RAJA, KUMAR SWAMY (MD)
Entity Type:Individual
Prefix:DR
First Name:KUMAR
Middle Name:SWAMY
Last Name:RAJA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17822 BEACH BLVD
Mailing Address - Street 2:SUITE 321
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-7101
Mailing Address - Country:US
Mailing Address - Phone:714-842-9353
Mailing Address - Fax:714-847-6864
Practice Address - Street 1:17822 BEACH BLVD
Practice Address - Street 2:SUITE 321
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-7101
Practice Address - Country:US
Practice Address - Phone:714-842-9353
Practice Address - Fax:714-847-6864
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26451174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A264510Medicaid
CA00A264510Medicaid
CAA26451Medicare PIN