1508079302 NPI number — KAVITHA KUMBUM M.D.

Table of content: KAVITHA KUMBUM M.D. (NPI 1508079302)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508079302 NPI number — KAVITHA KUMBUM M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KUMBUM
Provider First Name:
KAVITHA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JANUMPALLI
Provider Other First Name:
KAVITHA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1508079302
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10597
Provider Second Line Business Mailing Address:
AUSTIN GASTROENTEROLOGY, PA
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78766-5242
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-485-5889
Provider Business Mailing Address Fax Number:
512-420-0397

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1111 W 34TH ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78705-1900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-454-4588
Provider Business Practice Location Address Fax Number:
512-459-9869
Provider Enumeration Date:
05/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  Q0094 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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