Provider Demographics
NPI:1790975258
Name:JULIUS C KPADUWA MEDICAL CORPORATION
Entity Type:Organization
Organization Name:JULIUS C KPADUWA MEDICAL CORPORATION
Other - Org Name:MOTHER AND CHILD HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:MD
Authorized Official - Prefix:MR
Authorized Official - First Name:JULIUS
Authorized Official - Middle Name:C
Authorized Official - Last Name:KPADUWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-454-1801
Mailing Address - Street 1:9573 GARVEY AVE
Mailing Address - Street 2:STE 17
Mailing Address - City:S EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91733-4606
Mailing Address - Country:US
Mailing Address - Phone:626-454-1801
Mailing Address - Fax:626-454-2203
Practice Address - Street 1:16008 AMAR RD
Practice Address - Street 2:
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91744-2203
Practice Address - Country:US
Practice Address - Phone:626-330-9535
Practice Address - Fax:626-330-2661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG51500207VX0000X
CAA56261208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0085702Medicaid