Healthcare Provider Details

I. General information

NPI: 1407710908
Provider Name (Legal Business Name): KORTNI FERGUSON MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 SAN RAMON AVE
MOUNTAIN VIEW CA
94043-2939
US

IV. Provider business mailing address

PO BOX 390899
MOUNTAIN VIEW CA
94039-0899
US

V. Phone/Fax

Practice location:
  • Phone: 916-420-8559
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: KORTNI FERGUSON
Title or Position: PSYCHIATRY PHYSICIAN
Credential: MD
Phone: 916-420-8559