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General NPI Number Information
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NPI Number | 1285634931
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Entity Type | Individual
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Provider Name | KIRAN KUMAR VALLAM M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/22/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 317 N DELAWARE ST
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City | KENNEWICK
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State | WA
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Zip | 99336-7750
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Country | US
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Telephone | 509-736-5550
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Fax | 509-737-8281
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Provider Business Mailing Address
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Address Line | 317 N DELAWARE ST
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City | KENNEWICK
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State | WA
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Zip | 99336-7750
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Country | US
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Telephone | 509-736-5550
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Fax | 509-737-8281
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | FE00045283
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License Number State | WA
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