KENNY A KARYADI PHD
NPI 1699279679
Clinical Neuropsychologist in Los Angeles, CA

Q: What is Kenny Karyadi's NPI number?

The NPI number for Kenny Karyadi is 1699279679. It was assigned to this individual provider in the NPPES registry on March 22, 2018.

Q: What is Kenny Karyadi's specialty?

The primary specialty registered for this NPI is Clinical Neuropsychologist with taxonomy code 103G00000X.

Q: When was this NPI record last updated?

The NPPES record for Kenny Karyadi was last updated on December 3, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since March 22, 2018PECOS Enrolled

11835 W OLYMPIC BLVD STE 1265E, LOS ANGELES, CA 90064(310) 273-4843(310) 273-5056 Get Directions Write a Review

NPPES record last updated: December 3, 2021. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Dec 3, 2021, Jun 18, 2020, Mar 22, 2018 (3 updates tracked since 2018).

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About Kenny A Karyadi Phd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KENNY A KARYADI PHD (NPI 1699279679) is an individual clinical neuropsychologist in Los Angeles, California, licensed in California (PSY29812) and active in the NPI registry since March 2018. He is enrolled in Medicare PECOS and is a graduate of Other (2016).

NPPES Registry Identity

NPI1699279679

Entity TypeIndividualMale

Primary Taxonomy103G00000X

Provider Legal NameKENNY A KARYADICredential: PHD

Location Address11835 W OLYMPIC BLVD STE 1265ELos Angeles, CA 90064-5814

Mailing Address268 W Hospitality Ln, Ste 300San Bernardino, CA 92408-3241 · (909) 651-4518 · Fax (909) 651-4586

Phone(310) 273-4843

Fax(310) 273-5056

Sole ProprietorNo

Medical School CMSOtherGraduated 2016

Enumeration DateMarch 22, 2018

Last NPPES UpdateDecember 3, 20213 updates tracked since enumeration

NPPES CertifiedJune 18, 2020

✔ NPI 1699279679 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinical NeuropsychologistBehavioral Health & Social Service Providers

Taxonomy Code103G00000X

License✔ Licensed in CA · PSY29812

Definition

A clinical psychologist who applies principles of assessment and intervention based upon the scientific study of human behavior as it relates to normal and abnormal functioning of the central nervous system. The specialty is dedicated to enhancing the understanding of brain-behavior relationships and the application of such knowledge to human problems.

11835 W OLYMPIC BLVD STE 1265E, Los Angeles, CA 90064

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kenny A Karyadi Phd is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID840552881

PECOS Enrollment IDI20180402002256

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. KRISTEN VIRGINIA EDDY PSYD, MACL

Psychologist (Clinical)