Healthcare Provider Details

I. General information

NPI: 1821250564
Provider Name (Legal Business Name): KORY DAVID STOTESBERY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2970 CAMINO DIABLO STE 300
WALNUT CREEK CA
94597-4001
US

IV. Provider business mailing address

2970 CAMINO DIABLO STE 300
WALNUT CREEK CA
94597-4001
US

V. Phone/Fax

Practice location:
  • Phone: 925-360-5264
  • Fax:
Mailing address:
  • Phone: 925-360-5264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number20A12798
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA12798
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: