Individual provider Active NPI

Vamsi Krishna Vennam, DO

  • Psychiatry Physician
  • San Diego, CA
National Provider Identifier
1679070569
Registry record updated May 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
20A19415 Issued in CA
Practice address
15373 Innovation Dr Ste 390
San Diego, CA 92128-3429
Phone
(858) 673-3360
NPI assigned
Apr 9, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 1, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 20A19415 CA Primary

Addresses

Primary practice location

15373 Innovation Dr Ste 390
San Diego, CA 92128-3429

Mailing address

3835 N Freeway Blvd Ste 100
Sacramento, CA 95834-1954
Phone (916) 576-7900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20240801000300 CA Practitioner - Psychiatry 7315294162 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Lincoln Mem Univ, Debusk Col of Osteopathic Med, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

15373 Innovation Dr
Suite 390
San Diego, CA 92128-3429
Phone (619) 528-4600

6010 Hidden Valley Rd
Suite 115
Carlsbad, CA 92011-4219
Phone (855) 501-1004

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
20A19415CAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mark David Levine, MD Burlingame PC Psychiatry CurrentSince Jul 17, 2024 Accepting new patients
Mark David Levine M.D. Professional Corporation Psychiatry CurrentSince Jul 17, 2024 Accepting new patients

Locations

6010 Hidden Valley Rd
Ste 115
Carlsbad, CA 92011
Phone (760) 797-8494

12865 Pointe del Mar Way
Ste 210
Del Mar, CA 92014
Phone (858) 259-0599

3835 N Freeway Blvd
Ste 100
Sacramento, CA 95834
Phone (916) 576-7898

15373 Innovation Dr
Ste 390
San Diego, CA 92128
Phone (858) 673-3360

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1523232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777593600000",
    "number": "1679070569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3835 N FREEWAY BLVD STE 100",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958341954",
            "telephone_number": "916-576-7900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15373 INNOVATION DR STE 390",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921283429",
            "telephone_number": "858-673-3360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VENNAM",
        "first_name": "VAMSI KRISHNA",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-09",
        "last_updated": "2026-05-01",
        "certification_date": "2026-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "20A19415",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.