Provider Demographics
NPI:1073679338
Name:PREM K. KAMBOJ, M.D.P.C.
Entity Type:Organization
Organization Name:PREM K. KAMBOJ, M.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PREM
Authorized Official - Middle Name:K
Authorized Official - Last Name:KAMBOJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-686-3824
Mailing Address - Street 1:1062 N CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-2251
Mailing Address - Country:US
Mailing Address - Phone:559-686-3824
Mailing Address - Fax:559-686-3741
Practice Address - Street 1:1062 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-2251
Practice Address - Country:US
Practice Address - Phone:559-686-3824
Practice Address - Fax:559-686-3741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32580208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0010160Medicaid