Kelly Grace Wynkoop, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

36764 Issued in CA

Practice address

400 S Sepulveda Blvd Ste 247
Manhattan Beach, CA 90266-6876

Phone

(310) 798-6496

NPI assigned

Oct 5, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Chiropractic

Education

University of Southern California Keck School of Medicine, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Beach Cities Orthopedics and Sports MedicineGroup PAC ID 7517014251, 33 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Beach Cities Orthopedics and Sports Medicine

  • Orthopaedic Surgery Physician
  • Manhattan Beach, CA
  • NPI 1750539672
  Medicare reassignment Care Compare group NPD
• Beach Cities Orthopedics & Sports Medicine

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Torrance, CA
  • NPI 1104247139
  NPD

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

{
    "created_epoch": "1696464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696464000000",
    "number": "1184404196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "936 1ST ST APT 2",
            "city": "HERMOSA BEACH",
            "state": "CA",
            "postal_code": "902545365",
            "telephone_number": "631-384-2511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 S SEPULVEDA BLVD STE 247",
            "city": "MANHATTAN BEACH",
            "state": "CA",
            "postal_code": "902666876",
            "telephone_number": "310-798-6496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYNKOOP",
        "first_name": "KELLY",
        "middle_name": "GRACE",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-10-05",
        "last_updated": "2023-10-05",
        "certification_date": "2023-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "36764",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather G Wood, D.D.S.
• Kristin Woolley, M.D.
• Andrea W Wu, MD
• Monica S. Wu, PH.D.
• Tina Wu, MD
• Anthony Rikio Yamada, DDS
• Shari Yamada, PHARM. D.
• Austyn Lynn Yarbrough, DC
• Justin Yaros, LMFT
• Mariam Yazdipour, M.D.

• Chiropractor in Manhattan Beach, CA
• Providers in Manhattan Beach, CA by specialty
• Chiropractor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.