Basic Information
| Provider Information | |||||||||
| NPI: | 1750641536 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DR KUSUM T NIGAM INTERNAL MEDICINE PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2980 N BEVERLY GLEN CIR | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900771726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104749809 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4402 CHURCHMAN AVE | ||||||||
| Address2: | STE 410 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402151190 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5023676322 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2012 | ||||||||
| LastUpdateDate: | 05/25/2012 | ||||||||
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| AuthorizedOfficialLastName: | NIGAM | ||||||||
| AuthorizedOfficialFirstName: | KUSUM | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5023676322 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | DR KUSUM T NIGAM INTERNAL MEDICINE PLLC | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332900000X | Y | Suppliers | Non-Pharmacy Dispensing Site |
No ID Information.