Provider Demographics
NPI:1851414247
Name:KUMAR, IRINA (PA)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:KUMAR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3529 FIRESTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-3031
Mailing Address - Country:US
Mailing Address - Phone:323-566-1700
Mailing Address - Fax:323-566-3816
Practice Address - Street 1:3529 FIRESTONE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-3031
Practice Address - Country:US
Practice Address - Phone:323-566-1700
Practice Address - Fax:323-566-3816
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13974363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA13974OtherPHYSICIAN ASSISTANT