Provider Demographics
NPI:1821153453
Name:KUMAR, KEERAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KEERAN
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 1:320 SANTA FE DR STE 308
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5139
Mailing Address - Country:US
Mailing Address - Phone:858-764-3837
Mailing Address - Fax:760-230-6566
Practice Address - Street 1:320 SANTA FE DR STE 308
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5139
Practice Address - Country:US
Practice Address - Phone:858-764-3837
Practice Address - Fax:760-230-6566
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95239207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABY117ZMedicare PIN