Provider Demographics
NPI:1619965688
Name:KUMAR, SMITHA (MD)
Entity Type:Individual
Prefix:DR
First Name:SMITHA
Middle Name:
Last Name:KUMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9460 NO NAME UNO
Mailing Address - Street 2:115
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-3537
Mailing Address - Country:US
Mailing Address - Phone:408-842-3133
Mailing Address - Fax:408-842-2229
Practice Address - Street 1:9460 NO NAME UNO
Practice Address - Street 2:115
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-3537
Practice Address - Country:US
Practice Address - Phone:408-842-3133
Practice Address - Fax:408-842-2229
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88107207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI44427Medicare UPIN
CA00A881071Medicare PIN
CAP00325581Medicare PIN