NPIMap

Organization Active NPI

WK Medical Group

  • Psychiatry Physician
  • San Jose, CA
National Provider Identifier
1588083992
Registry record updated Oct 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
WK MEDICAL GROUP
Practice address
4850 Union Ave
San Jose, CA 95124-5156
Phone
(800) 913-2615
NPI assigned
Apr 14, 2014
Last updated
Oct 2, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2026

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

Authorized official

Name
Yevgeniy Tilman
Title
Executive Director
Phone
(800) 913-2615

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary
Child & Adolescent Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0804X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X

Addresses

Primary practice location

4850 Union Ave
San Jose, CA 95124-5156

Mailing address

4850 Union Ave
San Jose, CA 95124-5156
Phone (408) 559-3403

Other practice location 1

2235 Douglas Blvd Ste 500
Roseville, CA 95661-4266
Phone (800) 913-2615

Other practice location 2

1575 Old Bayshore Hwy Ste 201
Burlingame, CA 94010-1616
Phone (800) 913-2615

Other practice location 3

2542 S Bascom Ave Ste 100
Campbell, CA 95008-5541
Phone (800) 913-2615

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160601000362 CA Part B Supplier - Clinic/Group Practice 6103116348 Receives reassigned benefits from 24 practitioners
Practice locations: Roseville, CA; Sunnyvale, CA; San Jose, CA; Campbell, CA; Burlingame, CA

National Provider Directory

National Provider Directory
Tax ID family
LGTC Group6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1575 Old Bayshore Hwy
Ste 201
Burlingame, CA 94010
Phone (408) 542-0399

2235 Douglas Blvd
Ste 500
Roseville, CA 95661
Phone (916) 625-6878

508 Gibson Dr
Ste 114
Roseville, CA 95678
Phone (916) 694-0555

1298 Kifer Rd
Ste 515
Sunnyvale, CA 94086
Phone (408) 559-3403

Practitioners & affiliated clinicians

Practitioners 128

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 128

NPI Registry JSON

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

{
    "created_epoch": "1397433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790899200000",
    "number": "1588083992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4850 UNION AVE",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951245156",
            "telephone_number": "408-559-3403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4850 UNION AVE",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951245156",
            "telephone_number": "800-913-2615"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2235 Douglas Blvd Ste 500",
            "address_purpose": "LOCATION",
            "city": "Roseville",
            "state": "CA",
            "postal_code": "956614266",
            "country_code": "US",
            "telephone_number": "800-913-2615",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1575 Old Bayshore Hwy Ste 201",
            "address_purpose": "LOCATION",
            "city": "Burlingame",
            "state": "CA",
            "postal_code": "940101616",
            "country_code": "US",
            "telephone_number": "800-913-2615",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2542 S Bascom Ave Ste 100",
            "address_purpose": "LOCATION",
            "city": "Campbell",
            "state": "CA",
            "postal_code": "950085541",
            "country_code": "US",
            "telephone_number": "800-913-2615",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WK MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-14",
        "last_updated": "2026-10-02",
        "certification_date": "2026-10-02",
        "status": "A",
        "authorized_official_last_name": "TILMAN",
        "authorized_official_first_name": "YEVGENIY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "800-913-2615"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.