Healthcare Provider Details

I. General information

NPI: 1174227094
Provider Name (Legal Business Name): JUSTIN ISAAC KAMKAR DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 N FRESNO ST
FRESNO CA
93701-2302
US

IV. Provider business mailing address

4659 SALOMA AVE
SHERMAN OAKS CA
91403-2512
US

V. Phone/Fax

Practice location:
  • Phone: 559-499-6450
  • Fax:
Mailing address:
  • Phone: 818-269-9456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25905
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: