Primary Care of Walnut Creek

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

A126559 Issued in CA

Legal business name

PRIMARY CARE OF WALNUT CREEK

Practice address

120 La Casa Via Ste 101
Walnut Creek, CA 94598-3092

Phone

(925) 296-0344

Fax

(925) 947-5424

NPI assigned

Feb 28, 2018

Organization subpart

No

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

Authorized official

Name

Yevgeny Klebanov, MD

Title

Physician

Phone

(925) 296-0344

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1519776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519776000000",
    "number": "1689176232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 LA CASA VIA STE 101",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945983092",
            "telephone_number": "925-296-0344",
            "fax_number": "925-947-5424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 LA CASA VIA STE 101",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945983092",
            "telephone_number": "925-296-0344",
            "fax_number": "925-947-5424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY CARE OF WALNUT CREEK",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-28",
        "last_updated": "2018-02-28",
        "status": "A",
        "authorized_official_last_name": "KLEBANOV",
        "authorized_official_first_name": "YEVGENY",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "925-296-0344",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A126559",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Walnut Creek, CA
• Providers in Walnut Creek, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2018; 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.