Provider Demographics
NPI:1437241809
Name:KUMAR, SURINDER (MD, FACP,FASN,CCD)
Entity Type:Individual
Prefix:DR
First Name:SURINDER
Middle Name:
Last Name:KUMAR
Suffix:
Gender:M
Credentials:MD, FACP,FASN,CCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1595 SOQUEL DR.
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1719
Mailing Address - Country:US
Mailing Address - Phone:831-476-1551
Mailing Address - Fax:831-476-3421
Practice Address - Street 1:1595 SOQUEL DR.
Practice Address - Street 2:SUITE 210
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1719
Practice Address - Country:US
Practice Address - Phone:831-476-1551
Practice Address - Fax:831-476-3241
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA320240207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA942809523OtherOLD TAX ID #
CA00A320240Medicaid
CAZZZ66323ZOtherBLUE SHIELD PROV. ID
CAP00237353OtherMEDICARE RR
CAZZZ66323ZOtherBLUE SHIELD PROV. ID
CAP00237353OtherMEDICARE RR