Provider Demographics
NPI:1972740520
Name:KASUMBA, KELVIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KELVIN
Middle Name:
Last Name:KASUMBA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3818 W 157TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-3501
Mailing Address - Country:US
Mailing Address - Phone:310-230-5016
Mailing Address - Fax:
Practice Address - Street 1:3818 W 157TH ST
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-3501
Practice Address - Country:US
Practice Address - Phone:310-230-5016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-18
Last Update Date:2009-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMTA 40055246QL0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QL0901XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyLaboratory Management, Diplomate