Kendahl Wallis-Lang

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

2425 Geary Blvd
San Francisco, CA 94115-3358

Phone

(408) 931-5258

NPI assigned

Nov 27, 2018

Reactivated

May 8, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1543276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715126400000",
    "number": "1316417991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2425 GEARY BLVD",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941153358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2425 GEARY BLVD",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941153358",
            "telephone_number": "408-931-5258"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "39210 State St. Suite 220",
            "address_purpose": "LOCATION",
            "city": "Fremont",
            "state": "CA",
            "postal_code": "94538",
            "country_code": "US",
            "telephone_number": "510-894-4135",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLIS-LANG",
        "first_name": "KENDAHL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-27",
        "last_updated": "2024-05-08",
        "certification_date": "2024-05-08",
        "deactivation_date": "2024-04-04",
        "reactivation_date": "2024-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "CA",
            "license": "46-1305562",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susannah Turner Wallenstrom, MPH RD
• Robert M Walley, DDS
• Margaret Ingrid Wallhagen, RN, GNP, PHD
• Dina Wallin, MD
• Wendy Anne Wallin, PA
• Christopher James Wallis, M.D.
• Jonathan Marc Wallis, LCSW
• Benjamin Nicholas Walls, RN
• Jessica Leigh Walls, M.D.
• Tierra Shardai Walls

• Student in an Organized Health Care Education/Training Program in San Francisco, CA
• Providers in San Francisco, CA by specialty
• Student in an Organized Health Care Education/Training Program in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.