Healthcare Provider Details

I. General information

NPI: 1346401080
Provider Name (Legal Business Name): JULIE KAY VAISHAMPAYAN MD MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 OAKDALE RD
MODESTO CA
95355-4593
US

IV. Provider business mailing address

917 OAKDALE RD
MODESTO CA
95355-4593
US

V. Phone/Fax

Practice location:
  • Phone: 209-558-7700
  • Fax: 209-558-8184
Mailing address:
  • Phone: 209-558-7700
  • Fax: 209-558-8184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberC53831
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberC53831
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: