Provider Demographics
NPI:1669405569
Name:SHETH, KUSUM A (MD)
Entity type:Individual
Prefix:DR
First Name:KUSUM
Middle Name:A
Last Name:SHETH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 S BERNARDO AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-1022
Mailing Address - Country:US
Mailing Address - Phone:408-733-6000
Mailing Address - Fax:408-733-6012
Practice Address - Street 1:755 S BERNARDO AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-1022
Practice Address - Country:US
Practice Address - Phone:408-733-6000
Practice Address - Fax:408-733-6012
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC41385208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics