Provider Demographics
NPI:1114446135
Name:BRIJESH KADAM MD INC.
Entity Type:Organization
Organization Name:BRIJESH KADAM MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIJESH
Authorized Official - Middle Name:
Authorized Official - Last Name:KADAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-431-1652
Mailing Address - Street 1:PO BOX 2626
Mailing Address - Street 2:
Mailing Address - City:LOS BANOS
Mailing Address - State:CA
Mailing Address - Zip Code:93635-1726
Mailing Address - Country:US
Mailing Address - Phone:305-431-1652
Mailing Address - Fax:
Practice Address - Street 1:1253 W I ST
Practice Address - Street 2:
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-3930
Practice Address - Country:US
Practice Address - Phone:209-710-6333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1457545832OtherNPI
CAA109208OtherCALIFORNIA MEDICAL BOARD
FK0949442OtherDEA