Provider Demographics
NPI:1760500540
Name:KUMAR, NISCHAL
Entity Type:Individual
Prefix:
First Name:NISCHAL
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 1:1395 KIMIYO ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95206-5630
Mailing Address - Country:US
Mailing Address - Phone:209-234-0377
Mailing Address - Fax:209-234-0387
Practice Address - Street 1:1395 KIMIYO ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95206-5630
Practice Address - Country:US
Practice Address - Phone:209-234-0377
Practice Address - Fax:209-234-0387
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTN01249FOtherPROVIDER NUMBER