Provider Demographics
NPI:1770865271
Name:SINHA, KUSUM
Entity Type:Individual
Prefix:
First Name:KUSUM
Middle Name:
Last Name:SINHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4208 ASTOR HOLLOW ST
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-4877
Mailing Address - Country:US
Mailing Address - Phone:415-259-4275
Mailing Address - Fax:
Practice Address - Street 1:14280 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3328
Practice Address - Country:US
Practice Address - Phone:510-730-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP444231183500000X
CARPH63822183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist