Provider Demographics
NPI:1548403173
Name:RAVICHANDRAN KUMAR, PREETHI (DO)
Entity Type:Individual
Prefix:DR
First Name:PREETHI
Middle Name:
Last Name:RAVICHANDRAN KUMAR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1498 PACIFIC AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-4208
Mailing Address - Country:US
Mailing Address - Phone:844-546-5287
Mailing Address - Fax:888-370-2434
Practice Address - Street 1:8280 W WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-3612
Practice Address - Country:US
Practice Address - Phone:702-492-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-13
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1548403173207R00000X
NVDO1776208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist