Individual provider Active NPI

Kristin Zeising, PSY.D.

  • Clinical Psychologist
  • San Diego, CA
National Provider Identifier
1720091069
Registry record updated Apr 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PSY19164 Issued in CA
Practice address
12625 High Bluff Dr Ste 104
San Diego, CA 92130-2053
Phone
(858) 414-0097
Fax
(858) 793-1124
NPI assigned
Aug 15, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 8, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY19164 CA Primary

Addresses

Primary practice location

12625 High Bluff Dr Ste 104
San Diego, CA 92130-2053

Mailing address

12625 High Bluff Dr
Ste 104
San Diego, CA 92130-2054
Phone (858) 414-0097

Other identifiers 1

IdentifierTypeStateIssuer
11477705OtherCACAQH ID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.
Opted out of Medicare
Yes, effective Jan 1, 2018 through Jan 1, 2028

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
PSY19164CAMDClinical Psychologist
19164CAMDFamily Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1270684800000",
    "number": "1720091069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12625 HIGH BLUFF DR",
            "address_2": "STE 104",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921302054",
            "telephone_number": "858-414-0097",
            "fax_number": "858-793-1124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12625 HIGH BLUFF DR STE 104",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921302053",
            "telephone_number": "858-414-0097",
            "fax_number": "858-793-1124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZEISING",
        "first_name": "KRISTIN",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-15",
        "last_updated": "2010-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY19164",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH ID",
            "identifier": "11477705",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.