Provider Demographics
NPI:1508079302
Name:KUMBUM, KAVITHA (MD)
Entity Type:Individual
Prefix:
First Name:KAVITHA
Middle Name:
Last Name:KUMBUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAVITHA
Other - Middle Name:
Other - Last Name:JANUMPALLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 10597
Mailing Address - Street 2:AUSTIN GASTROENTEROLOGY, PA
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78766-5242
Mailing Address - Country:US
Mailing Address - Phone:512-485-5889
Mailing Address - Fax:512-420-0397
Practice Address - Street 1:1111 W 34TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1900
Practice Address - Country:US
Practice Address - Phone:512-454-4588
Practice Address - Fax:512-459-9869
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ0094207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology