Provider Demographics
NPI:1649049750
Name:NIPA, UMME KULSUM
Entity type:Individual
Prefix:
First Name:UMME
Middle Name:KULSUM
Last Name:NIPA
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 1:10270 E TARON DR APT 30
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-8228
Mailing Address - Country:US
Mailing Address - Phone:916-306-3356
Mailing Address - Fax:
Practice Address - Street 1:7215 55TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2659
Practice Address - Country:US
Practice Address - Phone:916-803-2124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109781122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist