Individual provider Active NPI

Kylie Tweed Kumasaka Evans, PA

  • Physician Assistant
  • Sacramento, CA
National Provider Identifier
1649617606
Registry record updated Sep 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA22965 Issued in CA
Practice address
4001 J St
Sacramento, CA 95819-3626
Phone
(916) 453-4828
NPI assigned
May 31, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA22965 CA Primary

Addresses

Primary practice location

4001 J St
Sacramento, CA 95819-3626

Mailing address

350 Twin Ponds LN
Lincoln, CA 95648-9625

Other names 1

  • Kylie Kumasaka Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251014000080 CA Practitioner - Physician Assistant 4688161771 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Stanford University School of Medicine, 2013
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

10545 Armstrong Ave
Suite 1200
Mather, CA 95655-4101

10850 White Rock Rd
Rancho Cordova, CA 95670-6044

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
22965CAMDPhysical Therapist
PA22965CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the Univ of Ca Current Accepting new patients
Regents of the Univ of Ca CurrentSince Aug 20, 2025 Accepting new patients
Regents of the Univ of Ca CurrentSince Aug 20, 2025 Accepting new patients
Regents of the Univ of Ca Past Accepting new patients

Locations

2221 Stockton Blvd
Sacramento, CA 95817
Phone (916) 734-2680

2521 Stockton Blvd
Ste 3200
Sacramento, CA 95817
Phone (916) 734-3112

4001 J St
Sacramento, CA 95819
Phone (916) 453-4037

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1369958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757289600000",
    "number": "1649617606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 TWIN PONDS LN",
            "city": "LINCOLN",
            "state": "CA",
            "postal_code": "956489625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4001 J ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958193626",
            "telephone_number": "916-453-4828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUMASAKA EVANS",
        "first_name": "KYLIE",
        "middle_name": "TWEED",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-31",
        "last_updated": "2025-09-08",
        "certification_date": "2025-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA22965",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KYLIE",
            "last_name": "KUMASAKA",
            "credential": "PA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.