Active NPI
Kevin Wallace, ND
- Naturopath
- Modesto, CA
National Provider Identifier
1659760700
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Naturopath
- License
- 707
- Practice address
- 205 Judith LN
Modesto, CA 95350-4413 - Phone
- (209) 809-4251
- NPI assigned
- Jan 13, 2015
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Naturopath | 175F00000X | 707 | CA | Primary |
Addresses
Primary practice location
205 Judith LN
Modesto, CA 95350-4413
Mailing address
2842 N Richey Blvd
Tucson, AZ 85716-2023
Phone (520) 396-4866
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 707 | CA | MD | Naturopath |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1421107200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1614038400000",
"number": "1659760700",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2842 N RICHEY BLVD",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857162023",
"telephone_number": "520-396-4866"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "205 JUDITH LN",
"city": "MODESTO",
"state": "CA",
"postal_code": "953504413",
"telephone_number": "209-809-4251"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "KEVIN",
"name_prefix": "Dr.",
"credential": "ND",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-01-13",
"last_updated": "2021-02-23",
"certification_date": "2021-02-23",
"status": "A"
},
"taxonomies": [
{
"code": "175F00000X",
"taxonomy_group": "",
"desc": "Naturopath",
"state": "CA",
"license": "707",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.