NPIMap

Organization Active NPI

Kory Stotesbery DO, Inc.

  • Adolescent and Children Mental Health Clinic/Center
  • Walnut Creek, CA
National Provider Identifier
1295193670
Registry record updated Feb 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
License
20A12798 Issued in CA
Legal business name
KORY STOTESBERY DO, INC.
Practice address
1501 N Broadway
Suite 200
Walnut Creek, CA 94596-4296
Phone
(925) 322-0418
NPI assigned
Feb 1, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2016

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

Authorized official

Name
Dr. Kory Stotesbery, DONPI 1821250564
Title
President
Phone
(925) 322-0418

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X 20A12798 CA
Adolescent and Children Mental Health Clinic/Center 261QM0855X 20A12798 CA Primary

Addresses

Primary practice location

1501 N Broadway
Suite 200
Walnut Creek, CA 94596-4296

Mailing address

1501 N Broadway
Suite 200
Walnut Creek, CA 94596-4296
Phone (925) 322-0418

Other names 1

  • SF Bay Psychiatry Doing business as

National Provider Directory

National Provider Directory

Locations

1501 N Broadway
Ste 200
Walnut Creek, CA 94596
Phone (925) 322-0418

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1454284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454284800000",
    "number": "1295193670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 N BROADWAY",
            "address_2": "SUITE 200",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945964296",
            "telephone_number": "925-322-0418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 N BROADWAY",
            "address_2": "SUITE 200",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945964296",
            "telephone_number": "925-322-0418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KORY STOTESBERY DO, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-01",
        "last_updated": "2016-02-01",
        "status": "A",
        "authorized_official_last_name": "STOTESBERY",
        "authorized_official_first_name": "KORY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "925-322-0418",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "CA",
            "license": "20A12798",
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "CA",
            "license": "20A12798",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SF Bay Psychiatry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Walnut Creek, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2016; 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.