Healthcare Provider Details

I. General information

NPI: 1790975258
Provider Name (Legal Business Name): JULIUS C KPADUWA MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 04/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16008 AMAR RD
CITY OF INDUSTRY CA
91744-2203
US

IV. Provider business mailing address

9573 GARVEY AVE STE 17
S EL MONTE CA
91733-4606
US

V. Phone/Fax

Practice location:
  • Phone: 626-330-9535
  • Fax: 626-330-2661
Mailing address:
  • Phone: 626-454-1801
  • Fax: 626-454-2203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberG51500
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA56261
License Number StateCA

VIII. Authorized Official

Name: MR. JULIUS C KPADUWA
Title or Position: MD
Credential: MD
Phone: 626-454-1801