Active NPI
Kyle Tanedo
- Physical Therapist
- San Mateo, CA
National Provider Identifier
1326593351
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 291708
- Practice address
- 77 N San Mateo Dr
Suite 2
San Mateo, CA 94401-2889 - Phone
- (650) 652-2376
- Fax
- (650) 652-9097
- NPI assigned
- Aug 19, 2016
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 291708 | CA | Primary |
Addresses
Primary practice location
77 N San Mateo Dr
Suite 2
San Mateo, CA 94401-2889
Mailing address
1860 El Camino Real
Suite 420
Burlingame, CA 94010-3127
Phone (650) 652-2376
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 291708 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1471564800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1471564800000",
"number": "1326593351",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1860 EL CAMINO REAL",
"address_2": "SUITE 420",
"city": "BURLINGAME",
"state": "CA",
"postal_code": "940103127",
"telephone_number": "650-652-2376",
"fax_number": "650-652-9097"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "77 N SAN MATEO DR",
"address_2": "SUITE 2",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944012889",
"telephone_number": "650-652-2376",
"fax_number": "650-652-9097"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TANEDO",
"first_name": "KYLE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-08-19",
"last_updated": "2016-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "291708",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Mateo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 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.