Provider Demographics
NPI:1386642130
Name:STOKES, KUSUM G (MD)
Entity Type:Individual
Prefix:DR
First Name:KUSUM
Middle Name:G
Last Name:STOKES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6630
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95502-6630
Mailing Address - Country:US
Mailing Address - Phone:707-443-4869
Mailing Address - Fax:707-442-5095
Practice Address - Street 1:3200 WALFORD AVE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-4828
Practice Address - Country:US
Practice Address - Phone:707-443-4869
Practice Address - Fax:707-442-5095
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34267207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A274350Medicaid
CAA34267OtherCALIFORNIA MEDICAL LIC
CADP522ZOtherMEDICARE ID
CA00A274350Medicaid