Healthcare Provider Details

I. General information

NPI: 1396271797
Provider Name (Legal Business Name): JOSHUA ABRAHAM KANJI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 03/04/2025
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9939 MAGNOLIA AVE
RIVERSIDE CA
92503-3528
US

IV. Provider business mailing address

495 E RINCON ST STE 215
CORONA CA
92879-1378
US

V. Phone/Fax

Practice location:
  • Phone: 855-505-7467
  • Fax: 877-409-2156
Mailing address:
  • Phone: 951-523-0117
  • Fax: 877-409-2156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA171274
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: