Healthcare Provider Details

I. General information

NPI: 1225103286
Provider Name (Legal Business Name): JAMES KIEFFER MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3796 N FIRST
FRESNO CA
93726
US

IV. Provider business mailing address

3796 N FIRST
FRESNO CA
93726
US

V. Phone/Fax

Practice location:
  • Phone: 559-222-9798
  • Fax: 559-222-3965
Mailing address:
  • Phone: 559-222-9798
  • Fax: 559-222-3965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG22949
License Number StateCA

VIII. Authorized Official

Name: JAMES RICHARD KIEFFER
Title or Position: PRESIDENT
Credential: MD
Phone: 559-222-9798