Provider Demographics
NPI:1689657496
Name:KUMAR, VASANTH K (MD)
Entity type:Individual
Prefix:DR
First Name:VASANTH
Middle Name:K
Last Name:KUMAR
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 1:5245 VISTA LEJANA LN
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-1860
Mailing Address - Country:US
Mailing Address - Phone:213-595-6383
Mailing Address - Fax:
Practice Address - Street 1:5245 VISTA LEJANA LN
Practice Address - Street 2:
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-1860
Practice Address - Country:US
Practice Address - Phone:213-595-6383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32885207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A328850Medicaid
CAA84401Medicare UPIN
CAA32885Medicare ID - Type Unspecified