Active NPI
Jack Kenneth Deitchman, MD
- Preventive Medicine/Occupational Environmental Medicine Physician
- Grass Valley, CA
National Provider Identifier
1346254141
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Preventive Medicine/Occupational Environmental Medicine Physician
- License
- G26297
- Practice address
- 140 Litton Drive
Suite 110
Grass Valley, CA 95945 - Phone
- (530) 274-8483
- Fax
- (530) 271-2067
- NPI assigned
- Jul 28, 2006
- 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 |
|---|---|---|---|---|
| Preventive Medicine/Occupational Environmental Medicine Physician | 2083P0500X | G26297 | CA | Primary |
Addresses
Primary practice location
140 Litton Drive
Suite 110
Grass Valley, CA 95945
Mailing address
140 Litton Drive
Suite 110
Grass Valley, CA 95945
Phone (530) 274-8483
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G26297 | CA | MD | Preventive Medicine/Occupational Environmental Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1236211200000",
"number": "1346254141",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "140 LITTON DRIVE",
"address_2": "SUITE 110",
"city": "GRASS VALLEY",
"state": "CA",
"postal_code": "95945",
"telephone_number": "530-274-8483",
"fax_number": "530-271-2067"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "140 LITTON DRIVE",
"address_2": "SUITE 110",
"city": "GRASS VALLEY",
"state": "CA",
"postal_code": "95945",
"telephone_number": "530-274-8483",
"fax_number": "530-271-2067"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEITCHMAN",
"first_name": "JACK",
"middle_name": "KENNETH",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-28",
"last_updated": "2009-03-05",
"status": "A"
},
"taxonomies": [
{
"code": "2083P0500X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine",
"state": "CA",
"license": "G26297",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grass Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.