Provider Demographics
NPI:1053103267
Name:KALYANAM HEALTH
Entity type:Organization
Organization Name:KALYANAM HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PARAG
Authorized Official - Middle Name:
Authorized Official - Last Name:BHARADWAJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-651-2247
Mailing Address - Street 1:5300 BEACH BLVD STE 110-384
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-1250
Mailing Address - Country:US
Mailing Address - Phone:714-651-2247
Mailing Address - Fax:
Practice Address - Street 1:2101 N WATERMAN AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-4836
Practice Address - Country:US
Practice Address - Phone:714-651-2247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Single Specialty