Active NPI
John M. Kendra, PH.D.
- Psychologist
- Roseville, CA
National Provider Identifier
1962580951
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY4391
- Practice address
- 2130 Professional Dr Ste 220
Roseville, CA 95661-3780 - Phone
- (916) 780-0580
- Fax
- (530) 622-2793
- NPI assigned
- Nov 1, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY4391 | CA | Primary |
Addresses
Primary practice location
2130 Professional Dr Ste 220
Roseville, CA 95661-3780
Mailing address
PO Box 1561
Placerville, CA 95667-1561
Phone (916) 780-0580
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY4391 | CA | MD | Psychologist |
| 4391 | CA | MD | School Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1962580951",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1561",
"city": "PLACERVILLE",
"state": "CA",
"postal_code": "956671561",
"telephone_number": "916-780-0580",
"fax_number": "530-622-2793"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2130 PROFESSIONAL DR STE 220",
"city": "ROSEVILLE",
"state": "CA",
"postal_code": "956613780",
"telephone_number": "916-780-0580",
"fax_number": "530-622-2793"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENDRA",
"first_name": "JOHN",
"middle_name": "M.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY4391",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roseville, 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.