Provider Demographics
NPI:1609952381
Name:KUMAR, AJITH J (MD)
Entity type:Individual
Prefix:
First Name:AJITH
Middle Name:J
Last Name:KUMAR
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-3502
Mailing Address - Country:US
Mailing Address - Phone:208-743-9986
Mailing Address - Fax:208-743-1318
Practice Address - Street 1:2124 12TH AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-3502
Practice Address - Country:US
Practice Address - Phone:208-743-9986
Practice Address - Fax:208-743-1318
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-11158207RN0300X
WAM000036107207RN0300X
WAMD00036107207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1107572Medicaid
F97125Medicare UPIN
WA04001Medicare ID - Type Unspecified