=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114446135
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRIJESH KADAM MD INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2017
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1253 W I ST
-----------------------------------------------------
City | LOS BANOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93635-3930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-710-6333
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2626
-----------------------------------------------------
City | LOS BANOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93635-1726
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-431-1652
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. BRIJESH KADAM
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 305-431-1652
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2080A0000X
-----------------------------------------------------
Taxonomy Name | Pediatric Adolescent Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------