Kenneth Vereschagin, MD

Primary specialty

Pediatric Sports Medicine PhysicianTaxonomy code 2080S0010X

License

G61515 Issued in CA

Practice address

2652 El Camino Real
Santa Clara, CA 95051-3041

Phone

(408) 524-5952

NPI assigned

Oct 19, 2006

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

State licenses

Interoperability endpoints

• Direct secure messaging: kvereschagin58871@hisp.ehr.sutterhealth.org

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1322784000000",
    "number": "1497837785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2350 W EL CAMINO REAL",
            "address_2": "2ND FLOOR",
            "city": "MOUNTAIN VIEW",
            "state": "CA",
            "postal_code": "940406201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2652 EL CAMINO REAL",
            "city": "SANTA CLARA",
            "state": "CA",
            "postal_code": "950513041",
            "telephone_number": "408-524-5952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VERESCHAGIN",
        "first_name": "KENNETH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2011-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080S0010X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Sports Medicine",
            "state": "CA",
            "license": "G61515",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tiffany Amber Venegas, LCSW
• Sarah Anne Venkatesan
• Priya Venkatesh, MD
• Jeya Venugopalakrishnan, MD
• Mary Dorothy Vera
• Jennifer Verzosa
• Via Rehabilitation Services, Inc.
• Victory Transportation
• Antonell Vida
• Chelsea Marie Vielhauer, MSW, LCSW

• Pediatric Sports Medicine Physician in Santa Clara, CA
• Providers in Santa Clara, CA by specialty
• Pediatric Sports Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2011; 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.