Kenji Christian Miyamoto, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

35078 Issued in CA

Practice address

1000 Wilshire Blvd Ste 240
Los Angeles, CA 90017-6279

Phone

(424) 201-1600

NPI assigned

Jan 9, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Executive Mental Health, IncGroup PAC ID 0345209102, 47 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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.

• Executive Mental Health, Inc.

  • Mental Health Counselor
  • Los Angeles, CA
  • NPI 1275670036
  Medicare reassignment Care Compare group
• Brian Wu MD PHD Inc

  • Psychiatry Physician
  • San Gabriel, CA
  • NPI 1528639481
  NPD
• Crossroads Institute for Psychotherapy and Assessment, Inc

  • Clinical Psychologist
  • Torrance, CA
  • NPI 1831432806
  NPD

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

{
    "created_epoch": "1389225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717718400000",
    "number": "1194147116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "833 E GRINNELL DR",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915011215",
            "telephone_number": "818-846-2449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 WILSHIRE BLVD STE 240",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900176279",
            "telephone_number": "424-201-1600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIYAMOTO",
        "first_name": "KENJI",
        "middle_name": "CHRISTIAN",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-01-09",
        "last_updated": "2024-06-07",
        "certification_date": "2024-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "35078",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Derek Miyamoto, MSW
• Eric Koji Miyamoto, O.D
• Jennifer Miyamoto
• Justin Miyamoto, M.D.
• Kari Emily Miyamoto, FNP-C
• Marya Miyamoto, M.D
• William Miyamoto
• Kellie Chiemi Miyashima-Singson, OTD, OTR/L
• Shin Miyata, M.D.
• Stanley Mitsuo Miyawaki, D.M.D., M.S.

• Clinical Psychologist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.