Healthcare Provider Details

I. General information

NPI: 1629434113
Provider Name (Legal Business Name): VALLEY CHILDREN'S SPECIALTY MEDICAL GROUP - PULMONOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 01/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 VALLEY CHILDRENS PL
MADERA CA
93636-8761
US

IV. Provider business mailing address

9300 VALLEY CHILDRENS PL
MADERA CA
93636-8761
US

V. Phone/Fax

Practice location:
  • Phone: 559-353-5550
  • Fax: 559-353-5587
Mailing address:
  • Phone: 559-353-5550
  • Fax: 559-353-5587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: DEVONNA KAJI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 559-353-5700