Provider Demographics
NPI:1134556004
Name:KUMAR, UNKNOWN SHAVETA
Entity type:Individual
Prefix:
First Name:UNKNOWN SHAVETA
Middle Name:
Last Name:KUMAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 QUINTANA WAY
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-3652
Mailing Address - Country:US
Mailing Address - Phone:408-368-8371
Mailing Address - Fax:
Practice Address - Street 1:396 ANO NUEVO AVE
Practice Address - Street 2:APT 216
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085-4176
Practice Address - Country:US
Practice Address - Phone:408-368-8371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-08
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA630021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice