Provider Demographics
NPI:1639286719
Name:KUMAR, SANJIV
Entity type:Individual
Prefix:
First Name:SANJIV
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 1:927 E MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:UVALDE
Mailing Address - State:TX
Mailing Address - Zip Code:78801-5660
Mailing Address - Country:US
Mailing Address - Phone:830-278-2020
Mailing Address - Fax:830-278-1040
Practice Address - Street 1:927 E MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:UVALDE
Practice Address - State:TX
Practice Address - Zip Code:78801-5660
Practice Address - Country:US
Practice Address - Phone:830-278-2020
Practice Address - Fax:830-278-1040
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9141174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142084601Medicaid
TX142084601Medicaid