Healthcare Provider Details

I. General information

NPI: 1235219106
Provider Name (Legal Business Name): JOSEPH BAKHOUM MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 04/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1837 W DOROTHEA AVE
VISALIA CA
93277-7363
US

IV. Provider business mailing address

PO BOX 3730
VISALIA CA
93278-3730
US

V. Phone/Fax

Practice location:
  • Phone: 559-636-8071
  • Fax: 559-636-8072
Mailing address:
  • Phone: 559-636-8071
  • Fax: 559-636-8072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA41373
License Number StateCA

VIII. Authorized Official

Name: MRS. CINDY EWING
Title or Position: OFFICE MANAGER
Credential:
Phone: 559-636-8071