Kjell Erik Rudestam, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY 5930 Issued in CA

Practice address

2020 Alameda Padre Serra
Suite217
Santa Barbara, CA 93103-1756

Phone

(805) 569-2540

Fax

(805) 687-4590

NPI assigned

Mar 26, 2007

Sex

Male

Sole proprietor

Yes

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

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Oct 1, 2017 through Oct 1, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1376661512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3924 FOOTHILL RD",
            "city": "SANTA BARBARA",
            "state": "CA",
            "postal_code": "931101208",
            "telephone_number": "805-569-2540",
            "fax_number": "805-687-4590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 ALAMEDA PADRE SERRA",
            "address_2": "SUITE217",
            "city": "SANTA BARBARA",
            "state": "CA",
            "postal_code": "931031756",
            "telephone_number": "805-569-2540",
            "fax_number": "805-687-4590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDESTAM",
        "first_name": "KJELL",
        "middle_name": "ERIK",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY 5930",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert R. Ruby, DDS
• Cailyn Katsev Ruck, OD
• Clifford J Ruddle, D.D.S.
• Rudy Ruderman, LMFT
• Janice Rudestam, PH.D.
• Lynn A Rudman, MD
• Bindu Rudramurthy
• Kymberlee Sue Ruff, M.F.T.
• Oziel Ruffo, RN
• Francesca Ruggeri

• Clinical Psychologist in Santa Barbara, CA
• Providers in Santa Barbara, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.