Johnmark Vanness II

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Practice address

4545 Georgetown PL
Stockton, CA 95207-6215

Phone

(209) 955-1139

Fax

(209) 955-1143

NPI assigned

Oct 25, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1635120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704672000000",
    "number": "1679237861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3818 SCOTTSDALE RD",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952406805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4545 GEORGETOWN PL",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952076215",
            "telephone_number": "209-955-1139",
            "fax_number": "209-955-1143"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "430 N Pilgrim St",
            "address_purpose": "LOCATION",
            "city": "Stockton",
            "state": "CA",
            "postal_code": "952054428",
            "country_code": "US",
            "telephone_number": "209-466-0853",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VANNESS",
        "first_name": "JOHNMARK",
        "name_suffix": "II",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-10-25",
        "last_updated": "2024-01-08",
        "certification_date": "2024-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CA",
            "license": "13809",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200806425",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shoua Vang
• Susan Vang
• Thomas Vang
• Tria Vang
• Wa Vang
• David Michael Vannucci, PTA
• Richard Vanover, O.D.
• Kenneth Robert Vanroekel II
• Charles Vansicklen, DDS
• James Harrold Vansicklen Jr., DDS

• Professional Counselor in Stockton, CA
• Providers in Stockton, CA by specialty
• Professional Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2024; 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.