Active NPI
KSP Health - California LLC
- Pediatrics Physician
- Sacramento, CA
National Provider Identifier
1093596033
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- Legal business name
- KSP HEALTH - CALIFORNIA LLC
- Doing business as
- KSP HEALTH - CALIFORNIA LLC
- Practice address
- 1401 21St St Ste R
Sacramento, CA 95811-5226 - Phone
- (234) 260-6212
- NPI assigned
- Oct 6, 2023
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Muthukumar Vellaichamy, MD
- Title
- Owner
- Phone
- (234) 260-6212
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 12
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Registered Nurse | 163WP0200X | |||
| Pediatric Dermatology Physician | 207NP0225X | |||
| Pediatrics Physician | 208000000X | Primary | ||
| Developmental - Behavioral Pediatrics Physician | 2080P0006X | |||
| Pediatric Neurodevelopmental Disabilities Physician | 2080P0008X | |||
| Pediatric Allergy/Immunology Physician | 2080P0201X | |||
| Pediatric Cardiology Physician | 2080P0202X | |||
| Pediatric Critical Care Medicine Physician | 2080P0203X | |||
| Pediatric Endocrinology Physician | 2080P0205X | |||
| Pediatric Gastroenterology Physician | 2080P0206X | |||
| Pediatric Hematology & Oncology Physician | 2080P0207X | |||
| Behavioral Neurology & Neuropsychiatry Physician | 2084B0040X |
Addresses
Primary practice location
1401 21St St Ste R
Sacramento, CA 95811-5226
Mailing address
6446 E Central Ave Ste 183
Wichita, KS 67206-1923
Phone (234) 260-6212
Other names 1
- KSP HEALTH - CALIFORNIA LLC
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Pediatric Critical Care Medicine Physician
- Topeka, KS
- NPI 1396778973
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1696550400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1696550400000",
"number": "1093596033",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6446 E CENTRAL AVE STE 183",
"city": "WICHITA",
"state": "KS",
"postal_code": "672061923",
"telephone_number": "234-260-6212"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1401 21ST ST STE R",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958115226",
"telephone_number": "234-260-6212"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "KSP HEALTH - CALIFORNIA LLC",
"organizational_subpart": "NO",
"enumeration_date": "2023-10-06",
"last_updated": "2023-10-06",
"certification_date": "2023-10-06",
"status": "A",
"authorized_official_last_name": "VELLAICHAMY",
"authorized_official_first_name": "MUTHUKUMAR",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "234-260-6212",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "163WP0200X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Registered Nurse, Pediatrics",
"state": null,
"license": null,
"primary": false
},
{
"code": "207NP0225X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Dermatology, Pediatric Dermatology",
"state": null,
"license": null,
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pediatrics",
"state": null,
"license": null,
"primary": true
},
{
"code": "2080P0006X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pediatrics, Developmental - Behavioral Pediatrics",
"state": null,
"license": null,
"primary": false
},
{
"code": "2080P0008X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pediatrics, Neurodevelopmental Disabilities",
"state": null,
"license": null,
"primary": false
},
{
"code": "2080P0201X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pediatrics, Pediatric Allergy/Immunology",
"state": null,
"license": null,
"primary": false
},
{
"code": "2080P0202X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pediatrics, Pediatric Cardiology",
"state": null,
"license": null,
"primary": false
},
{
"code": "2080P0203X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pediatrics, Pediatric Critical Care Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "2080P0205X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pediatrics, Pediatric Endocrinology",
"state": null,
"license": null,
"primary": false
},
{
"code": "2080P0206X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pediatrics, Pediatric Gastroenterology",
"state": null,
"license": null,
"primary": false
},
{
"code": "2080P0207X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pediatrics, Pediatric Hematology-Oncology",
"state": null,
"license": null,
"primary": false
},
{
"code": "2084B0040X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "KSP HEALTH - CALIFORNIA LLC",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.