Provider Demographics
NPI:1558371096
Name:KUMAR, KUMKUM (RD)
Entity Type:Individual
Prefix:MS
First Name:KUMKUM
Middle Name:
Last Name:KUMAR
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39500 ROCKCREST LN
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-3960
Mailing Address - Country:US
Mailing Address - Phone:734-660-0865
Mailing Address - Fax:
Practice Address - Street 1:39500 ROCKCREST LN
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-3960
Practice Address - Country:US
Practice Address - Phone:734-660-0865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered