Provider Demographics
NPI:1417114067
Name:KALLEM, PRIYANKA
Entity Type:Individual
Prefix:DR
First Name:PRIYANKA
Middle Name:
Last Name:KALLEM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5925 W LAS POSITAS BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-8537
Mailing Address - Country:US
Mailing Address - Phone:925-462-1755
Mailing Address - Fax:
Practice Address - Street 1:5925 W LAS POSITAS BLVD
Practice Address - Street 2:STE 100
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-8537
Practice Address - Country:US
Practice Address - Phone:925-462-1755
Practice Address - Fax:925-462-1650
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA106553207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program