Healthcare Provider Details

I. General information

NPI: 1861456634
Provider Name (Legal Business Name): RAM K KAMATH M D INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18564 US HIGHWAY 18 SUITE 103 & 104
APPLE VALLEY CA
92307-2312
US

IV. Provider business mailing address

18564 US HIGHWAY 18 SUITE 103 & 104
APPLE VALLEY CA
92307-2312
US

V. Phone/Fax

Practice location:
  • Phone: 760-946-4840
  • Fax: 760-947-4740
Mailing address:
  • Phone: 760-946-4840
  • Fax: 760-947-4740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA46329
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA50460
License Number StateCA

VIII. Authorized Official

Name: NANCY ANN GLASS
Title or Position: OFFICE MANAGER
Credential: M.A.
Phone: 760-946-4840