Kyle Addison

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

3649 Issued in CA

Practice address

6630 Marymonte CT
San Jose, CA 95120-4517

Phone

(408) 205-8996

NPI assigned

Apr 5, 2010

Last updated

Apr 5, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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

• Emq Families First

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • San Jose, CA
  • NPI 1104151059

  Residential Treatment Facility, Emotionally Disturbed Children

  NPD (past)

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

{
    "created_epoch": "1270425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1270425600000",
    "number": "1700101540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1058 S 5TH ST",
            "address_2": "APT. #201",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951126702",
            "telephone_number": "510-673-2285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6630 MARYMONTE CT",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951204517",
            "telephone_number": "408-205-8996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADDISON",
        "first_name": "KYLE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-04-05",
        "last_updated": "2010-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "CA",
            "license": "3649",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julia Addams, MD
• Brittany Addeo
• Addiction Recovery Center
• Elisa Addison, MFT
• Isaiah Addison
• Fareeda N Adeeb, M.D
• Nelson Kola Adeloye
• Semira A Adem
• Amina Hersi Aden
• Adham Zooby (Cal Mobile X-Ray & Ekg)

• Emotionally Disturbed Childrens' Residential Treatment Facility in San Jose, CA
• Providers in San Jose, CA by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2010; 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.