NPIMap

Organization Active NPI

Kerry B Evnin MD Inc a Professional Medical Corporation

  • Family Medicine Physician
  • Ceres, CA
National Provider Identifier
1902855588
Registry record updated Jun 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
655240 Issued in CA
Legal business name
KERRY B EVNIN MD INC A PROFESSIONAL MEDICAL CORPORATION
Practice address
3641 Mitchell Rd
H
Ceres, CA 95307
Phone
(209) 531-0154
Fax
(209) 531-0176
NPI assigned
May 9, 2006
Last updated
Jun 29, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2010

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

Authorized official

Name
Kerry B Evnin, MDNPI 1356536973
Title
President
Phone
(209) 531-0154

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 655240 CA Primary

Addresses

Primary practice location

3641 Mitchell Rd
H
Ceres, CA 95307

Mailing address

3641 Mitchell Rd
H
Ceres, CA 95307
Phone (209) 531-0154

National Provider Directory

National Provider Directory

Locations

3641 Mitchell Rd
Ste H
Ceres, CA 95307
Phone (209) 531-0154

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1147132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277769600000",
    "number": "1902855588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3641 MITCHELL RD",
            "address_2": "H",
            "city": "CERES",
            "state": "CA",
            "postal_code": "95307",
            "telephone_number": "209-531-0154",
            "fax_number": "209-531-0176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3641 MITCHELL RD",
            "address_2": "H",
            "city": "CERES",
            "state": "CA",
            "postal_code": "95307",
            "telephone_number": "209-531-0154",
            "fax_number": "209-531-0176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KERRY B EVNIN MD INC A PROFESSIONAL MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-09",
        "last_updated": "2010-06-29",
        "status": "A",
        "authorized_official_last_name": "EVNIN",
        "authorized_official_first_name": "KERRY",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "209-531-0154",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "655240",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ceres, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 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.