Provider Demographics
NPI:1639286719
Name:KUMAR, SANJIV
Entity Type:Individual
Prefix:
First Name:SANJIV
Middle Name:
Last Name:KUMAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 E SONTERRA BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4089
Mailing Address - Country:US
Mailing Address - Phone:210-615-8927
Mailing Address - Fax:210-545-3346
Practice Address - Street 1:1202 E SONTERRA BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4089
Practice Address - Country:US
Practice Address - Phone:210-615-8927
Practice Address - Fax:210-545-3346
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9141174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142084601Medicaid
TX142084601Medicaid