Individual
DR. PRASHANTH VASANTHA KUMAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12675 HESPERIA RD, VICTORVILLE, CA 92395-5878
(760) 241-3306
(760) 241-5037
Mailing address
12675 HESPERIA RD, VICTORVILLE, CA 92395-5878
(760) 241-3306
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A102091
CA
207RN0300X
Nephrology Physician
Primary
A102091
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BL408Z
MEDICARE PTAN
—
01
—
ZZZ26953Z
MEDICARE GROUP
CA
Enumeration date
06/15/2007
Last updated
03/07/2023
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