Jason V Kboudi, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

19485 Issued in TX

Practice address

8641 Wilshire Blvd Ste 205
Beverly Hills, CA 90211-2920

Phone

(310) 626-1212

Fax

(310) 626-0111

NPI assigned

Oct 24, 2006

Last updated

Jan 21, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jason V. Kboudi, DDS, Inc.

  dba Beverly Hills Complete Dentistry

  • General Practice Dentistry
  • Beverly Hills, CA
  • NPI 1285419002
  NPD Authorized official
• Advanced Smile Care, LLC

  • General Practice Dentistry
  • San Antonio, TX
  • NPI 1548579386
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642723200000",
    "number": "1003999707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8641 WILSHIRE BLVD STE 205",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902112920",
            "telephone_number": "310-626-1212",
            "fax_number": "310-626-0111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8641 WILSHIRE BLVD STE 205",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902112920",
            "telephone_number": "310-626-1212",
            "fax_number": "310-626-0111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KBOUDI",
        "first_name": "JASON",
        "middle_name": "V",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-24",
        "last_updated": "2022-01-21",
        "certification_date": "2022-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "13322",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "19485",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "82D611",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "803551",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alan Harris Kaye, DDS
• Marc J. Kayem, MD
• Emily Ann Kaymen, M.D.
• Narine Kazarian, FNP
• KB Management Ca LLC (KB Aesthetics)
• Simone Kboudi, MA, LPC
• Ilan Kedan, MD
• Ismail Ebrahim Keekeebhai
• David S Keen, D.D.S., M.S.
• Keihani Dental Corporation

• General Practice Dentistry in Beverly Hills, CA
• Providers in Beverly Hills, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.