Provider Demographics
NPI:1508051301
Name:AGRAWAL, SUMIT KISHORE (MD)
Entity Type:Individual
Prefix:DR
First Name:SUMIT
Middle Name:KISHORE
Last Name:AGRAWAL
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 1:801 WELCH ROAD
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-5739
Mailing Address - Country:US
Mailing Address - Phone:650-725-6500
Mailing Address - Fax:650-725-8502
Practice Address - Street 1:801 WELCH ROAD
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-5739
Practice Address - Country:US
Practice Address - Phone:650-725-6500
Practice Address - Fax:650-725-8502
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA96359207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology