Active NPI
Kiley Tkaczyk
- Doula
- Glendale, CA
National Provider Identifier
1104649698
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Doula
- Practice address
- 413 E Randolph St
Glendale, CA 91207-1450 - Phone
- (847) 373-4191
- NPI assigned
- Nov 4, 2024
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Doula | 374J00000X | CA | Primary |
Addresses
Primary practice location
413 E Randolph St
Glendale, CA 91207-1450
Mailing address
413 E Randolph St
Glendale, CA 91207-1450
Other practice location 1
825 Marshall St Apt 730
Redwood City, CA 94063-2177
Phone (408) 621-5723
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Doulanet | Doula | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Doula
- Redwood City, CA
- NPI 1194577635
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1730678400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1740096000000",
"number": "1104649698",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "413 E RANDOLPH ST",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912071450"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "413 E RANDOLPH ST",
"city": "GLENDALE",
"state": "CA",
"postal_code": "912071450",
"telephone_number": "847-373-4191"
}
],
"practiceLocations": [
{
"address_1": "825 Marshall St Apt 730",
"address_purpose": "LOCATION",
"city": "Redwood City",
"state": "CA",
"postal_code": "940632177",
"country_code": "US",
"telephone_number": "408-621-5723",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "TKACZYK",
"first_name": "KILEY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-11-04",
"last_updated": "2025-02-21",
"certification_date": "2025-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "374J00000X",
"taxonomy_group": "",
"desc": "Doula",
"state": "CA",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glendale, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.