Provider Demographics
NPI:1902955404
Name:GAUNDER, KUMARAN SEGARAN
Entity Type:Individual
Prefix:MR
First Name:KUMARAN
Middle Name:SEGARAN
Last Name:GAUNDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 PIEDMONT WAY
Mailing Address - Street 2:STE B
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-5017
Mailing Address - Country:US
Mailing Address - Phone:925-439-7500
Mailing Address - Fax:925-439-1227
Practice Address - Street 1:2151 PIEDMONT WAY
Practice Address - Street 2:STE B
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-5017
Practice Address - Country:US
Practice Address - Phone:925-439-7500
Practice Address - Fax:925-439-1227
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMTN01087FMedicaid