Provider Demographics
NPI:1710929575
Name:KUMAR, MOHAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAN
Middle Name:S
Last Name:KUMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MOHAN
Other - Middle Name:S
Other - Last Name:KUMAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 4897
Mailing Address - Street 2:DEPT. 510
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4897
Mailing Address - Country:US
Mailing Address - Phone:281-694-4555
Mailing Address - Fax:281-694-9555
Practice Address - Street 1:16969 N TEXAS AVE STE 100
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4094
Practice Address - Country:US
Practice Address - Phone:281-694-4555
Practice Address - Fax:281-694-9555
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9731207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG22753Medicare UPIN