Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Kenji Christian Miyamoto, PHD

Individual provider Addiction (Substance Use Disorder) Counselor · NPI 1194147116

Dr. Kenji Christian Miyamoto, PHD is a Clinical Psychologist in Los Angeles, California. Qualified in 2020, 6 years ago. Practices with Executive Mental Health, Inc, a 47-clinician group, accepts Medicare assignment and offers telehealth. Licensed in California.

Years since qualifying
6
Licensed in
CA
In the registry since
2014
Specialties on file
2
What do these letters mean?
PHD — Doctor of Philosophy
A research doctorate. In healthcare it usually sits alongside a clinical licence.

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Practice location Address checks out

1000 Wilshire Blvd Ste 240
Los Angeles, CA 90017-6279
Phone: (424) 201-1600
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Psychologist (primary) Taxonomy 103TC0700X · Licence 35078 (CA)
Addiction (Substance Use Disorder) Counselor Taxonomy 101YA0400X

Record details

NPI number1194147116
Entity typeIndividual (Type 1)
GenderMale
Credentials PHD
Sole proprietorYes
NPI enumeratedJanuary 9, 2014
Last updated in NPPESJune 7, 2024
Certification dateJune 7, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL PSYCHOLOGIST
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Executive Mental Health, Inc — 47 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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