Healthcare Provider Details

I. General information

NPI: 1700680147
Provider Name (Legal Business Name): CPH-COMPREHENSIVE PEDIATRIC HEATH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3351 EL CAMINO REAL STE 205
ATHERTON CA
94027-3864
US

IV. Provider business mailing address

3351 EL CAMINO REAL STE 205
ATHERTON CA
94027-3864
US

V. Phone/Fax

Practice location:
  • Phone: 650-503-8899
  • Fax:
Mailing address:
  • Phone: 650-503-8899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JULLY PADAM
Title or Position: MANAGER
Credential: MD
Phone: 650-503-8899