Active NPI
Kristen Melnyk, M.D.
- Psychiatry Physician
- Los Angeles, CA
National Provider Identifier
1851681159
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- A61954
- Practice address
- 12401 Wilshire Blvd Ste 304
Los Angeles, CA 90025-1087 - Phone
- (310) 476-9940
- Fax
- (310) 979-3212
- NPI assigned
- Apr 8, 2011
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | A61954 | CA | Primary |
Addresses
Primary practice location
12401 Wilshire Blvd Ste 304
Los Angeles, CA 90025-1087
Mailing address
12401 Wilshire Blvd Ste 304
Los Angeles, CA 90025-1087
Phone (310) 476-9940
Other names 1
- Dr. Kristen Melnyk
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Sep 20, 2022 through Sep 20, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A61954 | CA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1302220800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1302220800000",
"number": "1851681159",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12401 WILSHIRE BLVD STE 304",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900251087",
"telephone_number": "310-476-9940",
"fax_number": "310-979-3212"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12401 WILSHIRE BLVD STE 304",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900251087",
"telephone_number": "310-476-9940",
"fax_number": "310-979-3212"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MELNYK",
"first_name": "KRISTEN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-04-08",
"last_updated": "2011-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "A61954",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KRISTEN",
"last_name": "MELNYK",
"prefix": "DR.",
"credential": "M.D.",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.