Active NPI
Kathleen Anne Clanon, MD
- Allergy & Immunology Physician
- Oakland, CA
National Provider Identifier
1386654945
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Allergy & Immunology Physician
- License
- G56122
- Practice address
- 1411 E 31St Street
Oakland, CA 94602-1080 - Phone
- (510) 437-4323
- Fax
- (510) 437-5042
- NPI assigned
- Aug 8, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Allergy & Immunology Physician | 207K00000X | G56122 | CA | Primary |
Addresses
Primary practice location
1411 E 31St Street
Oakland, CA 94602-1080
Mailing address
1411 E 31St Street
Oakcare Medical Group
Oakland, CA 94602-1080
Phone (510) 437-4323
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G56122 | Medicaid | CA |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 56122 | CA | MD | Dentist |
| G56122 | CA | MD | Allergy & Immunology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154995200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1329782400000",
"number": "1386654945",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1411 E 31ST STREET",
"address_2": "OAKCARE MEDICAL GROUP",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946021080",
"telephone_number": "510-437-4323",
"fax_number": "510-437-5042"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1411 E 31ST STREET",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946021080",
"telephone_number": "510-437-4323",
"fax_number": "510-437-5042"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLANON",
"first_name": "KATHLEEN",
"middle_name": "ANNE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-08",
"last_updated": "2012-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "207K00000X",
"taxonomy_group": "",
"desc": "Allergy & Immunology",
"state": "CA",
"license": "G56122",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G56122",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.