NPIMap

Organization Active NPI

The Permanente Medical Group

  • Health Maintenance Organization
  • Vallejo, CA
National Provider Identifier
1962864785
Registry record updated Mar 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Maintenance OrganizationTaxonomy code 302R00000X
License
PSY27745 Issued in CA
Legal business name
THE PERMANENTE MEDICAL GROUP
Practice address
1761 Broadway St
Suite 100
Vallejo, CA 94589-2226
Phone
(707) 645-2700
NPI assigned
Mar 22, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2016

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

Authorized official

Name
Dr. Timothy Yen, PSY.D.
Title
Psychologist
Phone
(707) 645-2314

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Maintenance Organization 302R00000X PSY27745 CA Primary

Addresses

Primary practice location

1761 Broadway St
Suite 100
Vallejo, CA 94589-2226

Mailing address

1761 Broadway St
Suite 100
Vallejo, CA 94589-2226
Phone (707) 645-2700

National Provider Directory

National Provider Directory
Tax ID family
Kaiser Permanente2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1458604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458604800000",
    "number": "1962864785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1761 BROADWAY ST",
            "address_2": "SUITE 100",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945892226",
            "telephone_number": "707-645-2700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1761 BROADWAY ST",
            "address_2": "SUITE 100",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945892226",
            "telephone_number": "707-645-2700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PERMANENTE MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-22",
        "last_updated": "2016-03-22",
        "status": "A",
        "authorized_official_last_name": "YEN",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "707-645-2314",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "CA",
            "license": "PSY27745",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vallejo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2016; 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.