1114446135 NPI number — BRIJESH KADAM MD INC.

Table of content: (NPI 1114446135)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114446135 NPI number — BRIJESH KADAM MD INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIJESH KADAM MD INC.
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:
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:
1114446135
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2626
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS BANOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93635-1726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-431-1652
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1253 W I ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS BANOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93635-3930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-710-6333
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/11/2017

Additional Information

Authorized Official

Authorized Official Last Name:
KADAM
Authorized Official First Name:
BRIJESH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
305-431-1652

Provider Taxonomy Codes

  • Taxonomy code: 2080A0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1457545832 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: A109208 . This is a "CALIFORNIA MEDICAL BOARD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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