Provider Demographics
NPI:1477656932
Name:KUMAR, VIKRAM RAMKUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:VIKRAM
Middle Name:RAMKUMAR
Last Name:KUMAR
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 1:2069 VENEZIA ST
Mailing Address - Street 2:
Mailing Address - City:LOS BANOS
Mailing Address - State:CA
Mailing Address - Zip Code:93635-6438
Mailing Address - Country:US
Mailing Address - Phone:414-793-8336
Mailing Address - Fax:
Practice Address - Street 1:100 MISSION BLVD
Practice Address - Street 2:SUITE 2600
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-2534
Practice Address - Country:US
Practice Address - Phone:209-257-1722
Practice Address - Fax:209-257-1726
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90318208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics