Provider Demographics
NPI:1538373584
Name:KUMAR S. RAJA, M.D INC
Entity type:Organization
Organization Name:KUMAR S. RAJA, M.D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KUMAR
Authorized Official - Middle Name:SWAMY
Authorized Official - Last Name:RAJA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-875-9466
Mailing Address - Street 1:3562 VENTURE DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-7101
Mailing Address - Country:US
Mailing Address - Phone:714-875-9466
Mailing Address - Fax:714-847-6864
Practice Address - Street 1:3562 VENTURE DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-2536
Practice Address - Country:US
Practice Address - Phone:714-875-9466
Practice Address - Fax:714-847-6864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26451207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A264510Medicaid
CA00A264510Medicaid
CAA26451Medicare ID - Type UnspecifiedMEDICARE