Provider Demographics
NPI:1689681173
Name:KUMAR, RAJIV (MD)
Entity Type:Individual
Prefix:
First Name:RAJIV
Middle Name:
Last Name:KUMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30423 CANWOOD ST STE 140
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4315
Mailing Address - Country:US
Mailing Address - Phone:818-707-2130
Mailing Address - Fax:818-707-2131
Practice Address - Street 1:30423 CANWOOD ST STE 118
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4314
Practice Address - Country:US
Practice Address - Phone:818-707-2130
Practice Address - Fax:818-707-2131
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC506692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C506690Medicaid
CAD44136Medicare UPIN
CAC50669Medicare PIN