Active NPI
Mika Kakefuda Derynck, M.D.
- Specialist
- San Mateo, CA
National Provider Identifier
1477914307
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- GO79889
- Practice address
- 27 Hilltop Rd
San Mateo, CA 94402-1146 - Phone
- (415) 999-3933
- NPI assigned
- Mar 20, 2016
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Specialist | 174400000X | GO79889 | CA | Primary |
Addresses
Primary practice location
27 Hilltop Rd
San Mateo, CA 94402-1146
Mailing address
27 Hilltop Rd
San Mateo, CA 94402-1146
Phone (415) 999-3933
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GO79889 | Other | CA | CALIFORNIA MEDICAL LICENSE |
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 |
|---|---|---|---|
| GO79889 | CA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1458432000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458432000000",
"number": "1477914307",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "27 HILLTOP RD",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944021146",
"telephone_number": "415-999-3933"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "27 HILLTOP RD",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944021146",
"telephone_number": "415-999-3933"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERYNCK",
"first_name": "MIKA",
"middle_name": "KAKEFUDA",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-03-20",
"last_updated": "2016-03-20",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CA",
"license": "GO79889",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CALIFORNIA MEDICAL LICENSE",
"identifier": "GO79889",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Mateo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.