Provider Demographics
NPI:1982640371
Name:KUMAR, SARASA (MD)
Entity Type:Individual
Prefix:
First Name:SARASA
Middle Name:
Last Name:KUMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13768 ROSWELL AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-1401
Mailing Address - Country:US
Mailing Address - Phone:909-590-7356
Mailing Address - Fax:909-548-6871
Practice Address - Street 1:13768 ROSWELL AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-1401
Practice Address - Country:US
Practice Address - Phone:909-590-7356
Practice Address - Fax:909-548-6871
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA49540208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A495400Medicaid
CA11415033OtherCAQH
CA11415033OtherCAQH