Provider Demographics
NPI:1821705047
Name:KALLUMKAL, BIJU JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:BIJU
Middle Name:JOSEPH
Last Name:KALLUMKAL
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 1:2059 HILLMAN ST
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-1609
Mailing Address - Country:US
Mailing Address - Phone:818-648-9469
Mailing Address - Fax:
Practice Address - Street 1:2059 HILLMAN ST
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-1609
Practice Address - Country:US
Practice Address - Phone:559-605-0090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-28
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
CA11531207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program