Kerry Bruce Evnin, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

G55240 Issued in CA

Practice address

3641 Mitchell Rd
Ste H
Ceres, CA 95307

Phone

(209) 531-0154

Fax

(209) 531-0176

NPI assigned

Sep 6, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kerry B Evnin MD Inc a Professional Medical Corporation

  • Family Medicine Physician
  • Ceres, CA
  • NPI 1902855588
  Authorized official Same address or phone
• Silicon Valley TMS, PC

  • Psychiatry Physician
  • San Ramon, CA
  • NPI 1346949476
  NPD (past)

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

{
    "created_epoch": "1189036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190160000000",
    "number": "1356536973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3641 MITCHELL RD",
            "address_2": "STE H",
            "city": "CERES",
            "state": "CA",
            "postal_code": "95307",
            "telephone_number": "209-531-0154",
            "fax_number": "209-531-0176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3641 MITCHELL RD",
            "address_2": "STE H",
            "city": "CERES",
            "state": "CA",
            "postal_code": "95307",
            "telephone_number": "209-531-0154",
            "fax_number": "209-531-0176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVNIN",
        "first_name": "KERRY",
        "middle_name": "BRUCE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-06",
        "last_updated": "2007-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G55240",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leisa Suzanne Elliott
• Marisa Emmons
• Virgilio Celeste Ereso Sr., M.D.
• Frances Escamilla
• Theresa Sanchez Escobar
• Jessica Marie Fabela
• Dulce Farfan Ruiz
• Elizabeth Farias
• Heather Farrell, LVN
• Elvis M Fedalizo, MD

• Family Medicine Physician in Ceres, CA
• Providers in Ceres, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2007; 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.