Children'S Medical Clinic

Primary specialty

SpecialistTaxonomy code 174400000X

License

G031541 Issued in CA

Legal business name

CHILDREN'S MEDICAL CLINIC

Practice address

729 Sunrise Ave
Suite 501
Roseville, CA 95661-4565

Phone

(916) 786-5800

Fax

(916) 773-3001

NPI assigned

Dec 10, 2006

Organization subpart

No

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

Authorized official

Name

Dr. David L. Bannister, M.D.

Title

Owner

Phone

(916) 786-5800

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1165708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1821158114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "729 SUNRISE AVE",
            "address_2": "SUITE 501",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956614565",
            "telephone_number": "916-786-5800",
            "fax_number": "916-773-3001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "729 SUNRISE AVE",
            "address_2": "SUITE 501",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956614565",
            "telephone_number": "916-786-5800",
            "fax_number": "916-773-3001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BANNISTER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "916-786-5800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "G031541",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "A44802",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kaila Chhana
• Kimdavy Chheng
• Ruchika Sunil Chhibar, M.D.
• Chia Y. Chou, MD Inc.
• Annette Marie Chihorek, M.D.
• Katherine Chia CHI Chin
• Kevin Chin, MD
• Debbie Chinn-Davis, MAS, MS, RD
• Hui-Li Chiou, MD
• Venu Madhav Chippa, M.D.

• Specialist in Roseville, CA
• Providers in Roseville, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.