Provider Demographics
NPI:1649617606
Name:KUMASAKA EVANS, KYLIE TWEED (PA)
Entity type:Individual
Prefix:
First Name:KYLIE
Middle Name:TWEED
Last Name:KUMASAKA EVANS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KYLIE
Other - Middle Name:
Other - Last Name:KUMASAKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:350 TWIN PONDS LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-9625
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4001 J ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3626
Practice Address - Country:US
Practice Address - Phone:916-453-4828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-31
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22965363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant