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

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