Provider Demographics
NPI:1164684387
Name:IEM, STEPHANIE KEDHIA (DO)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:KEDHIA
Last Name:IEM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 E GRAND AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4466
Mailing Address - Country:US
Mailing Address - Phone:760-747-7512
Mailing Address - Fax:760-747-1253
Practice Address - Street 1:701 E GRAND AVE STE 100
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4466
Practice Address - Country:US
Practice Address - Phone:760-294-8898
Practice Address - Fax:760-294-8827
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-29
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9702207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine