1659560746 NPI number — B VIJAYA KUMAR MD PA

Table of content: (NPI 1659560746)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659560746 NPI number — B VIJAYA KUMAR MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
B VIJAYA KUMAR MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659560746
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2206 VALLEY BLOSSUM LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEAGUE CITY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77573-3977
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-935-8470
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 E SAN ANTONIO ST
Provider Second Line Business Practice Location Address:
SUITE 403W
Provider Business Practice Location Address City Name:
VICTORIA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77901-6040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-580-1500
Provider Business Practice Location Address Fax Number:
361-580-1507
Provider Enumeration Date:
10/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KUMAR
Authorized Official First Name:
BANGARUSWAMY
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
361-935-8470

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5252513 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 097036001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0067EW . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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