Healthcare Provider Details

I. General information

NPI: 1275775173
Provider Name (Legal Business Name): AMOL P KAMBOJ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2009
Last Update Date: 03/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4909 CENTENNIAL PLAZA WAY
BAKERSFIELD CA
93312-2011
US

IV. Provider business mailing address

4909 CENTENNIAL PLAZA WAY
BAKERSFIELD CA
93312-2011
US

V. Phone/Fax

Practice location:
  • Phone: 661-587-8110
  • Fax: 661-587-8220
Mailing address:
  • Phone: 661-587-8110
  • Fax: 661-587-8220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA106043
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberA106043
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: