Provider Demographics
NPI:1811990369
Name:SENTHILKUMAR, KANDASAMI (MD)
Entity type:Individual
Prefix:DR
First Name:KANDASAMI
Middle Name:
Last Name:SENTHILKUMAR
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 12685
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77726-2685
Mailing Address - Country:US
Mailing Address - Phone:409-838-4338
Mailing Address - Fax:
Practice Address - Street 1:740 HOSPITAL DR STE 100
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4663
Practice Address - Country:US
Practice Address - Phone:409-838-4338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-28
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL17402084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144156001Medicaid
TXH37525Medicare UPIN
TX144156001Medicaid