Provider Demographics
NPI:1245269406
Name:PURI-KUMAR, SUKSHAM (MD)
Entity type:Individual
Prefix:DR
First Name:SUKSHAM
Middle Name:
Last Name:PURI-KUMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40143 LUCINDA CT
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-3653
Mailing Address - Country:US
Mailing Address - Phone:510-573-1202
Mailing Address - Fax:
Practice Address - Street 1:39500 LIBERTY STREET
Practice Address - Street 2:TRI-CITY HEALTH CENTER
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538
Practice Address - Country:US
Practice Address - Phone:510-770-8133
Practice Address - Fax:510-770-8140
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52701208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics