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

Dr. Kyle Raynor Wicomb

Individual provider Internal Medicine Physician · NPI 1558865147

Dr. Kyle Raynor Wicomb is an Internal Medicine in Elmhurst, New York. Qualified in 2018, 8 years ago. Practices with 24 on Physicians of California PC, a 58-clinician group and accepts Medicare assignment. Licensed in California.

Years since qualifying
8
Licensed in
CA
In the registry since
2018
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Practice location Address checks out

7901 Broadway # A1-16
Elmhurst, NY 11373-1329
Phone: (718) 334-2488
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X · Licence A176702 (CA)

Record details

NPI number1558865147
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMarch 20, 2018
Last updated in NPPESJanuary 30, 2023
Certification dateJanuary 30, 2023
Mailing address2016 N 10th St Apt 3, El Centro, CA 92243-4462

Medicare enrollment

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

Medicare specialtyINTERNAL MEDICINE
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice 24 On Physicians Of California Pc — 58 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Elmhurst