Provider Demographics
NPI:1073169298
Name:CAJON MEDICAL GROUP PC
Entity Type:Organization
Organization Name:CAJON MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SYAM
Authorized Official - Middle Name:P
Authorized Official - Last Name:KUNAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-735-2446
Mailing Address - Street 1:1809 W REDLANDS BLVD
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-8054
Mailing Address - Country:US
Mailing Address - Phone:909-735-2446
Mailing Address - Fax:909-206-1553
Practice Address - Street 1:12555 CENTRAL AVE STE A
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-3569
Practice Address - Country:US
Practice Address - Phone:909-735-2446
Practice Address - Fax:909-206-1553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty