Nit Wichenkuer, MD
Individual provider Active NPI General Practice Physician · Ponoma, CA
NPI 1750337028 · NPPES record last updated Jul 13, 2026
Key facts
- NPI
- 1750337028
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Physician 208D00000X
- License
- C38312 (CA)
- Practice address
- 3530 West Pomona Blvd
Ponoma, CA 91769-0100 - Phone
- (909) 595-1221
- NPI assigned
- May 26, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C38312 | CA | MD | General Practice Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| State of California - Department of Developmental Services | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | C38312 | CA | |
| General Practice Physician | 208D00000X | C38312 | CA | Yes |
Addresses
Primary practice location
3530 West Pomona Blvd
Ponoma, CA 91769-0100
Mailing address
1600 9TH Street
Room 205 Mailstop 2-3
Sacramento, CA 95814-6414
Phone (916) 654-2431
Other names
- Nit Wich
Other providers in Ponoma, CA
All providers in Ponoma, CA · General Practice Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.