Individual provider Active NPI

Kesjana Cake, PSYD, MA

  • Clinical Psychologist
  • Riverside, CA
National Provider Identifier
1114157567
Registry record updated Sep 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
29835 Issued in CA
Practice address
5005 Canyon Crest Dr
Riverside, CA 92507-7721
Phone
(747) 224-2090
Fax
(747) 444-4969
NPI assigned
Jul 20, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Clinical Psychologist 103TC0700X 126135 IA
Clinical Psychologist 103TC0700X 29835 CA Primary

Addresses

Primary practice location

5005 Canyon Crest Dr
Riverside, CA 92507-7721

Mailing address

975 Flynn Rd
Camarillo, CA 93012-8704
Phone (805) 388-7740

Other practice location 1

975 Flynn Rd
Camarillo, CA 93012-8704
Phone (805) 388-7740

Other practice location 2

7755 Office Plaza Dr N Ste 105
West Des Moines, IA 50266-2339
Phone (747) 224-2090

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
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
126135IAMDClinical Psychologist
29835CAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Leili Zarbakhsh Integrated Individual and Family Therapy Prof. Corp. Clinical CurrentSince Sep 1, 2024 Accepting new patients
California Psychcare, Inc. PastSince Sep 1, 2024 Accepting new patients

Locations

5005 Canyon Crest Dr
Riverside, CA 92507
Phone (747) 224-2090

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1248048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725148800000",
    "number": "1114157567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "975 FLYNN RD",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "930128704",
            "telephone_number": "805-388-7740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5005 CANYON CREST DR",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925077721",
            "telephone_number": "747-224-2090",
            "fax_number": "747-444-4969"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "975 Flynn Rd",
            "address_purpose": "LOCATION",
            "city": "Camarillo",
            "state": "CA",
            "postal_code": "930128704",
            "country_code": "US",
            "telephone_number": "805-388-7740",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7755 Office Plaza Dr N Ste 105",
            "address_purpose": "LOCATION",
            "city": "West Des Moines",
            "state": "IA",
            "postal_code": "502662339",
            "country_code": "US",
            "telephone_number": "747-224-2090",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CAKE",
        "first_name": "KESJANA",
        "credential": "PSYD, MA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-20",
        "last_updated": "2024-09-01",
        "certification_date": "2024-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IA",
            "license": "126135",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "29835",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2024; 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.