Basic Information
| Provider Information | |||||||||
| NPI: | 1992963920 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KULUVA | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | ELAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2850 TELEGRAPH AVE | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947051192 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102048140 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2850 TELEGRAPH AVE | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947051192 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102048140 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2008 | ||||||||
| LastUpdateDate: | 09/27/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2084N0400X | 233709 | NY | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084P0800X | 233709 | NY | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084N0400X | A109267 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.