Healthcare Provider Details

I. General information

NPI: 1740190339
Provider Name (Legal Business Name): KYLE DAWSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6838 W SUNSET BLVD
LOS ANGELES CA
90028-7008
US

IV. Provider business mailing address

2229 24TH ST
SANTA MONICA CA
90405-1810
US

V. Phone/Fax

Practice location:
  • Phone: 323-461-3161
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number161497
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: