Active NPI
Kylene Richan Douglas
- Specialist
- Oakland, CA
National Provider Identifier
1851419147
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 5558
- Practice address
- 2570 98TH Ave
Oakland, CA 94605-4746 - Phone
- (530) 644-3758
- Fax
- (530) 644-3782
- NPI assigned
- Mar 26, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 5558 | CA | Primary |
Addresses
Primary practice location
2570 98TH Ave
Oakland, CA 94605-4746
Mailing address
PO Box 586
Camino, CA 95709-0586
Phone (530) 644-3758
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5558 | CA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174867200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1851419147",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 586",
"city": "CAMINO",
"state": "CA",
"postal_code": "957090586",
"telephone_number": "530-644-3758",
"fax_number": "530-644-3782"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2570 98TH AVE",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946054746",
"telephone_number": "530-644-3758",
"fax_number": "530-644-3782"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOUGLAS",
"first_name": "KYLENE",
"middle_name": "RICHAN",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CA",
"license": "5558",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oakland, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.