Active NPI
Edward Leon Kaftarian, M.D.
- Psychiatry Physician
- Alameda, CA
National Provider Identifier
1245376615
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- A98911
- Practice address
- 1080 Marina Village Pkwy Ste 100
Alameda, CA 94501-1078 - Phone
- (415) 279-3879
- NPI assigned
- Jan 30, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Forensic Psychiatry Physician | 2084F0202X | A98911 | CA | |
| Addiction Medicine (Psychiatry & Neurology) Physician | 2084A0401X | A98911 | CA | |
| Psychiatry Physician | 2084P0800X | A98911 | CA | Primary |
Addresses
Primary practice location
1080 Marina Village Pkwy Ste 100
Alameda, CA 94501-1078
Mailing address
3203 Fait Ave
Baltimore, MD 21224-4032
Phone (301) 437-5878
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A98911 | CA | MD | Forensic Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1552867200000",
"number": "1245376615",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3203 FAIT AVE",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212244032",
"telephone_number": "301-437-5878"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1080 MARINA VILLAGE PKWY STE 100",
"city": "ALAMEDA",
"state": "CA",
"postal_code": "945011078",
"telephone_number": "415-279-3879"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KAFTARIAN",
"first_name": "EDWARD",
"middle_name": "LEON",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-30",
"last_updated": "2019-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "2084F0202X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Forensic Psychiatry",
"state": "CA",
"license": "A98911",
"primary": false
},
{
"code": "2084A0401X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Addiction Medicine",
"state": "CA",
"license": "A98911",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "A98911",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Alameda, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.