Healthcare Provider Details

I. General information

NPI: 1114446135
Provider Name (Legal Business Name): BRIJESH KADAM MD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1253 W I ST
LOS BANOS CA
93635-3930
US

IV. Provider business mailing address

PO BOX 2626
LOS BANOS CA
93635-1726
US

V. Phone/Fax

Practice location:
  • Phone: 209-710-6333
  • Fax:
Mailing address:
  • Phone: 305-431-1652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIJESH KADAM
Title or Position: PRESIDENT
Credential: MD
Phone: 305-431-1652