Basic Information
Provider Information
NPI: 1760699557
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KEM
FirstName: KARUNA
MiddleName: SITH
NamePrefix:  
NameSuffix:  
Credential: D.O
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 3768
Address2:  
City: MERCED
State: CA
PostalCode: 953443768
CountryCode: US
TelephoneNumber: 2097233704
FaxNumber: 2097230272
Practice Location
Address1: 220 E 13TH ST
Address2:  
City: MERCED
State: CA
PostalCode: 953416250
CountryCode: US
TelephoneNumber: 2097233704
FaxNumber: 2097230272
Other Information
ProviderEnumerationDate: 05/17/2007
LastUpdateDate: 12/14/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X20A9517CAY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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