Provider Demographics
NPI:1780612846
Name:RAVI I KUMAR MD INC
Entity type:Organization
Organization Name:RAVI I KUMAR MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:I
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-992-2337
Mailing Address - Street 1:1001 VAN DORSTEN AVE
Mailing Address - Street 2:
Mailing Address - City:CORCORAN
Mailing Address - State:CA
Mailing Address - Zip Code:93212-2321
Mailing Address - Country:US
Mailing Address - Phone:559-992-2337
Mailing Address - Fax:559-992-3269
Practice Address - Street 1:1001 VAN DORSTEN AVE
Practice Address - Street 2:
Practice Address - City:CORCORAN
Practice Address - State:CA
Practice Address - Zip Code:93212-2321
Practice Address - Country:US
Practice Address - Phone:559-992-2337
Practice Address - Fax:559-992-3269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHM 53951 F261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A670100Medicaid
CA00A670100Medicaid