Krysta Dawn Wyatt, DACM, L.AC. DIPL.O.M

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

19062 Issued in CA

Practice address

1336 El Camino Real
San Carlos, CA 94070-5005

Phone

(650) 596-5616

NPI assigned

Oct 23, 2021

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Brielle E. Kelly, L.Ac., Inc.

  • Acupuncturist
  • San Carlos, CA
  • NPI 1679752505
  NPD (past)

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

{
    "created_epoch": "1634947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634947200000",
    "number": "1790449072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "231 FULTON ST",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "940621316",
            "telephone_number": "216-526-9066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1336 EL CAMINO REAL",
            "city": "SAN CARLOS",
            "state": "CA",
            "postal_code": "940705005",
            "telephone_number": "650-596-5616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYATT",
        "first_name": "KRYSTA",
        "middle_name": "DAWN",
        "credential": "DACM, L.AC. DIPL.O.M",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-23",
        "last_updated": "2021-10-23",
        "certification_date": "2021-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Acupuncturist",
            "state": "CA",
            "license": "19062",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jean Wu
• Mengru Wu, APCC
• Roger Wu
• Wilson Wu
• Ailina Wunderly
• Jing Xie
• XP Health Incorporated
• Janice Yang, PH.D.
• Jean Yang, D.M.D.
• Rayna Yi Yang, AUD

• Acupuncturist in San Carlos, CA
• Providers in San Carlos, CA by specialty
• Acupuncturist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.