Provider Demographics
NPI:1114988441
Name:KADAMBI, PRAMOD V (MD)
Entity Type:Individual
Prefix:DR
First Name:PRAMOD
Middle Name:V
Last Name:KADAMBI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2030
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93539-2030
Mailing Address - Country:US
Mailing Address - Phone:661-674-4222
Mailing Address - Fax:661-674-4220
Practice Address - Street 1:43723 20TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4784
Practice Address - Country:US
Practice Address - Phone:661-674-4222
Practice Address - Fax:661-674-4220
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84174174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A841740Medicaid
CAWA84174BMedicare ID - Type Unspecified
CA00A841740Medicaid