Active NPI
Kenneth Marvin Nowack
- Psychologist
- Santa Monica, CA
National Provider Identifier
1306783675
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY13758
- Practice address
- 2621 6TH St Apt 2
Santa Monica, CA 90405-4432 - Phone
- (310) 721-2918
- NPI assigned
- May 4, 2026
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY13758 | CA | Primary |
Addresses
Primary practice location
2621 6TH St Apt 2
Santa Monica, CA 90405-4432
Mailing address
2208 6TH St
Santa Monica, CA 90405-2406
Phone (310) 721-2918
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY13758 | CA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1777852800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1777852800000",
"number": "1306783675",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2208 6TH ST",
"city": "SANTA MONICA",
"state": "CA",
"postal_code": "904052406",
"telephone_number": "310-721-2918"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2621 6TH ST APT 2",
"city": "SANTA MONICA",
"state": "CA",
"postal_code": "904054432",
"telephone_number": "310-721-2918"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NOWACK",
"first_name": "KENNETH",
"middle_name": "MARVIN",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2026-05-04",
"last_updated": "2026-05-04",
"certification_date": "2026-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY13758",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Monica, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.