Active NPI
Vadim Derevyanko, L.AC
- Acupuncturist
- Livermore, CA
National Provider Identifier
1245573732
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- AC14899
- Practice address
- 1718 Holmes St
Livermore, CA 94550-6012 - Phone
- (925) 766-6101
- NPI assigned
- Apr 3, 2013
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | AC14899 | CA | Primary |
Addresses
Primary practice location
1718 Holmes St
Livermore, CA 94550-6012
Mailing address
4131 Bristlecone Way
Livermore, CA 94551
Phone (925) 766-6101
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AC14899 | CA | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1364947200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1364947200000",
"number": "1245573732",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4131 BRISTLECONE WAY",
"city": "LIVERMORE",
"state": "CA",
"postal_code": "94551",
"telephone_number": "925-766-6101"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1718 HOLMES ST",
"city": "LIVERMORE",
"state": "CA",
"postal_code": "945506012",
"telephone_number": "925-766-6101"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEREVYANKO",
"first_name": "VADIM",
"credential": "L.AC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-04-03",
"last_updated": "2013-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "CA",
"license": "AC14899",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Livermore, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.