NPIMap

Organization Active NPI

Westcoast Children's Clinic

  • Community/Behavioral Health Agency
  • Oakland, CA
National Provider Identifier
1114163987
Registry record updated Dec 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
020000193 Issued in CA
Legal business name
WESTCOAST CHILDREN'S CLINIC
Practice address
3301 E 12TH St Ste 259
Oakland, CA 94601-2940
Phone
(510) 269-9030
Fax
(510) 269-9031
NPI assigned
Dec 30, 2008
Last updated
Dec 9, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2011

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

Authorized official

Name
Dr. Kelley Bryan Gin, PSYD
Title
Director of Clinical Services
Phone
(510) 269-9042

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 020000193 CA Primary

Addresses

Primary practice location

3301 E 12TH St Ste 259
Oakland, CA 94601-2940

Mailing address

3301 E 12TH St Ste 259
Oakland, CA 94601-2940
Phone (510) 269-9030

National Provider Directory

National Provider Directory
Tax ID family
Westcoast Children's Clinic6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1230595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323388800000",
    "number": "1114163987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3301 E 12TH ST STE 259",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946012940",
            "telephone_number": "510-269-9030",
            "fax_number": "510-269-9031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3301 E 12TH ST STE 259",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946012940",
            "telephone_number": "510-269-9030",
            "fax_number": "510-269-9031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTCOAST CHILDREN'S CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-30",
        "last_updated": "2011-12-09",
        "status": "A",
        "authorized_official_last_name": "GIN",
        "authorized_official_first_name": "KELLEY",
        "authorized_official_middle_name": "BRYAN",
        "authorized_official_title_or_position": "DIRECTOR OF CLINICAL SERVICES",
        "authorized_official_telephone_number": "510-269-9042",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "CA",
            "license": "020000193",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oakland, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2011; 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.