Active NPI
Alexandre Grebenchtchikov
- Family Medicine Physician
- Kingman, AZ
National Provider Identifier
1053206797
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- R4611
- Practice address
- 3269 N Stockton Hill Rd
Kingman, AZ 86409-3619 - Phone
- (716) 560-1845
- NPI assigned
- Jun 12, 2025
- Last updated
- Jun 12, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | R4611 | AZ | Primary |
Addresses
Primary practice location
3269 N Stockton Hill Rd
Kingman, AZ 86409-3619
Mailing address
7802 E Sabino Hollow CT
Tucson, AZ 85750-7223
Phone (716) 560-1845
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R4611 | AZ | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1749686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1749686400000",
"number": "1053206797",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7802 E SABINO HOLLOW CT",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857507223",
"telephone_number": "716-560-1845"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3269 N STOCKTON HILL RD",
"city": "KINGMAN",
"state": "AZ",
"postal_code": "864093619",
"telephone_number": "716-560-1845"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREBENCHTCHIKOV",
"first_name": "ALEXANDRE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-06-12",
"last_updated": "2025-06-12",
"certification_date": "2025-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "AZ",
"license": "R4611",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kingman, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.