Individual provider Active NPI

Richard Mutembei Kinyamu, MBCHB

  • Student in an Organized Health Care Education/Training Program
  • Brooklyn, NY
National Provider Identifier
1396942629
Registry record updated Mar 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
450 Clarkson Ave
Box 1203
Brooklyn, NY 11203-2012
Phone
(718) 270-2902
NPI assigned
Jun 29, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary
Psychiatry Physician 2084P0800X 264444 NY

Addresses

Primary practice location

450 Clarkson Ave
Box 1203
Brooklyn, NY 11203-2012

Mailing address

1355 New York Ave
Apt 2D
Brooklyn, NY 11210-6159
Phone (949) 683-9837

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140318000642 NY Order and Referring Only - PsychiatryPractitioner - Psychiatry 6002047917

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
264444NYMDPsychiatry Physician

Networks

  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H1722

NPI Registry JSON

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

{
    "created_epoch": "1183075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1331078400000",
    "number": "1396942629",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1355 NEW YORK AVE",
            "address_2": "APT 2D",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112106159",
            "telephone_number": "949-683-9837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 CLARKSON AVE",
            "address_2": "BOX 1203",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112032012",
            "telephone_number": "718-270-2902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KINYAMU",
        "first_name": "RICHARD",
        "middle_name": "MUTEMBEI",
        "name_prefix": "Dr.",
        "credential": "MBCHB",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-29",
        "last_updated": "2012-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "264444",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

Verify at the official NPI Registry.