Individual provider Active NPI

Raj Kumar, MSC MBBS PA-C

  • Physician Assistant
  • Washington, DC
National Provider Identifier
1093707143
Registry record updated Mar 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
52699 Issued in CA
Practice address
330 C Street SW
Washington, DC 20202-9517
Phone
(202) 260-0428
Fax
(202) 401-2901
NPI assigned
Aug 16, 2005
Last updated
Mar 27, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 27, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA04339 TX
Medical Physician Assistant 363AM0700X CA
Physician Assistant 363A00000X 52699 CA Primary

Addresses

Primary practice location

330 C Street SW
Washington, DC 20202-9517

Mailing address

PO Box 771
Manteca, CA 95336-1133
Phone (812) 205-5470

Other practice location 1

36650 Road 112
Visalia, CA 93291-9517
Phone (812) 205-5470

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
52699CAMDMarriage & Family Therapist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648339200000",
    "number": "1093707143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 771",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "953361133",
            "telephone_number": "812-205-5470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 C STREET SW",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "202029517",
            "telephone_number": "202-260-0428",
            "fax_number": "202-401-2901"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "36650 Road 112",
            "address_purpose": "LOCATION",
            "city": "Visalia",
            "state": "CA",
            "postal_code": "932919517",
            "country_code": "US",
            "telephone_number": "812-205-5470",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KUMAR",
        "first_name": "RAJ",
        "name_prefix": "Mr.",
        "credential": "MSC MBBS PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-16",
        "last_updated": "2022-03-27",
        "certification_date": "2022-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA04339",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "52699",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, DC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.