Healthcare Provider Details

I. General information

NPI: 1558915504
Provider Name (Legal Business Name): CAJON MEDICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2019
Last Update Date: 07/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 N SANTA FE ST
HEMET CA
92543-4451
US

IV. Provider business mailing address

1809 W REDLANDS BLVD
REDLANDS CA
92373-8054
US

V. Phone/Fax

Practice location:
  • Phone: 909-735-2446
  • Fax: 909-206-1553
Mailing address:
  • Phone: 909-735-2446
  • Fax: 909-206-1553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SYAM P KUNAM
Title or Position: CEO
Credential: MD
Phone: 909-735-2446