MEDICARE: KMY PRIMARY CARE, INC

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
1	261QM1300X	Multi-Specialty Clinic/Center
2	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1427415785
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KMY PRIMARY CARE, INC

Provider Business Mailing Address
First Line	:	7210 N MILBURN AVE
Second Line	:	105
City	:	FRESNO
State	:	CA
Zip	:	93722-8448
Country	:	US
Telephone Number	:	559-277-3909
Fax Number	:	559-277-3090

Provider Business Practice Location Address
First Line	:	7210 N MILBURN AVE
Second Line	:	105
City	:	FRESNO
State	:	CA
Zip	:	93722-8448
Country	:	US
Telephone Number	:	559-277-3909
Fax Number	:	559-277-3090

Authorized Official
Title or Position	:	OWNER
Name	:	NAJEEBULLAH CHAUDHRY
Credential	:	MD
Telephone Number	:	559-277-3909

Provider Enumeration Date	:	01/18/2016
Last Update Date	:	01/18/2016

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