Basic Information
| Provider Information | |||||||||
| NPI: | 1508967548 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KUMAR | ||||||||
| FirstName: | PRADEEP | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 393 E WALNUT ST | ||||||||
| Address2: | GROUP & PROVIDER ENROLLMENT UNIT | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911886129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8885050043 | ||||||||
| FaxNumber: | 6264056768 | ||||||||
| Practice Location | |||||||||
| Address1: | 9353 IMPERIAL HIGHWAY | ||||||||
| Address2: | |||||||||
| City: | DOWNEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902423456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626574110 | ||||||||
| FaxNumber: | 5626574177 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2006 | ||||||||
| LastUpdateDate: | 12/21/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | G73865 | CA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.