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NPI Code Detail

MEDICARE: DR. PRIYANKA KALLEM

MEDICARE: DR. PRIYANKA KALLEM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2207QA0000XAdolescent Medicine (Family Medicine) PhysicianA106553CA

General Provider Information

NPI Number : 1417114067
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PRIYANKA KALLEM
Provider Business Mailing Address
First Line : 5925 W LAS POSITAS BLVD
Second Line : STE 100
City : PLEASANTON
State : CA
Zip : 94588-8537
Country : US
Telephone Number : 925-462-1755
Fax Number :
Provider Business Practice Location Address
First Line : 5925 W LAS POSITAS BLVD
Second Line : STE 100
City : PLEASANTON
State : CA
Zip : 94588-8537
Country : US
Telephone Number : 925-462-1755
Fax Number : 925-462-1650
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2008
Last Update Date : 06/14/2018

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Directions to “ DR. PRIYANKA KALLEM ” Practice Location

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