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General NPI Number Information
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NPI Number | 1659613693
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Entity Type | Organization
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Legal Business Name | IAM MEDICAL CLINIC
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Dates
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Enumeration Date | 03/16/2013
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Last Update Date | 03/16/2013
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Provider Practice Location Address
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Address Line | 5250 UNIVERSITY PKWY A
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City | SAN BERNARDINO
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State | CA
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Zip | 92407-7051
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Country | US
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Telephone | 909-684-9334
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Fax | 909-463-1426
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Provider Business Mailing Address
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Address Line | 5250 UNIVERSITY PKWY A
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City | SAN BERNARDINO
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State | CA
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Zip | 92407-7051
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Country | US
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Telephone | 909-684-9334
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Fax | 909-463-1426
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Authorized Official
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Title or Position | DIRECTOR
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Name | CHIOMA KALU
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Credential | M.D
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Telephone | 909-684-9334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A102218
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License Number State | CA
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