NPIMap

Organization Active NPI

Center for Developing Minds Medical Corporation

  • Developmental - Behavioral Pediatrics Physician
  • Los Gatos, CA
National Provider Identifier
1083748248
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental - Behavioral Pediatrics PhysicianTaxonomy code 2080P0006X
License
A62686 Issued in CA
Legal business name
CENTER FOR DEVELOPING MINDS MEDICAL CORPORATION
Practice address
15951 Los Gatos Blvd
Suite 6
Los Gatos, CA 95032-3428
Phone
(408) 358-1853
NPI assigned
Mar 16, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Damon Russell Korb, M.D.NPI 1164719498
Title
Director
Phone
(408) 358-1853

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental - Behavioral Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2080P0006X A62686 CA Primary

Addresses

Primary practice location

15951 Los Gatos Blvd
Suite 6
Los Gatos, CA 95032-3428

Mailing address

22990 Schulties Rd
Los Gatos, CA 95033-8703
Phone (408) 358-1853

National Provider Directory

National Provider Directory

Locations

15951 Los Gatos Blvd
Ste 6
Los Gatos, CA 95032
Phone (408) 358-1853

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1083748248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22990 SCHULTIES RD",
            "city": "LOS GATOS",
            "state": "CA",
            "postal_code": "950338703",
            "telephone_number": "408-358-1853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15951 LOS GATOS BLVD",
            "address_2": "SUITE 6",
            "city": "LOS GATOS",
            "state": "CA",
            "postal_code": "950323428",
            "telephone_number": "408-358-1853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR DEVELOPING MINDS MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KORB",
        "authorized_official_first_name": "DAMON",
        "authorized_official_middle_name": "RUSSELL",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "408-358-1853",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2080P0006X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": "CA",
            "license": "A62686",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Gatos, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.