Active NPI
Edwyne D Nazarian, MD
- Psychiatry Physician
- Kentfield, CA
National Provider Identifier
1093868655
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- A38982
- Practice address
- 1036 Sir Francis Drake Blvd
Kentfield, CA 94904-1427 - Phone
- (415) 456-9500
- Fax
- (415) 456-6604
- NPI assigned
- Jan 18, 2007
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | A38982 | CA | Primary |
Addresses
Primary practice location
1036 Sir Francis Drake Blvd
Kentfield, CA 94904-1427
Mailing address
2154 Fourth Street
San Rafael, CA 94901
Phone (415) 456-9500
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Apr 20, 2015 through Apr 20, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A38982 | CA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1552348800000",
"number": "1093868655",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2154 FOURTH STREET",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "94901",
"telephone_number": "415-456-9500",
"fax_number": "415-842-7691"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1036 SIR FRANCIS DRAKE BLVD",
"city": "KENTFIELD",
"state": "CA",
"postal_code": "949041427",
"telephone_number": "415-456-9500",
"fax_number": "415-456-6604"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NAZARIAN",
"first_name": "EDWYNE",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-18",
"last_updated": "2019-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "A38982",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kentfield, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.