Provider Demographics
NPI:1649290206
Name:KUMAR, DILEEP (MD)
Entity type:Individual
Prefix:
First Name:DILEEP
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:PO BOX 255849
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95865-5849
Mailing Address - Country:US
Mailing Address - Phone:916-854-6975
Mailing Address - Fax:916-854-6864
Practice Address - Street 1:3505 LONE TREE WAY
Practice Address - Street 2:STE #2
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-6067
Practice Address - Country:US
Practice Address - Phone:925-757-5790
Practice Address - Fax:925-757-0849
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42408207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C424080Medicaid
CAP00154064OtherRAILROAD MEDICARE
CA00C424082Medicare ID - Type Unspecified
CAA89137Medicare UPIN