Individual
AJITH J KUMAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2124 12TH AVE, LEWISTON, ID 83501-3502
(208) 743-9986
(208) 743-1318
Mailing address
2124 12TH AVE, LEWISTON, ID 83501-3502
(208) 743-9986
(208) 743-1318
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD00036107
WA
207RN0300X
Nephrology Physician
M-11158
ID
207RN0300X
Nephrology Physician
Primary
M000036107
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1107572
—
WA
Enumeration date
10/27/2006
Last updated
03/06/2025
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