Individual provider Active NPI

Kyle Thomas Cabahug

  • Physical Therapist
  • Redondo Beach, CA
National Provider Identifier
1053148601
Registry record updated Sep 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
306875 Issued in CA
Practice address
520 N Prospect Ave Ste 100
Redondo Beach, CA 90277-3033
Phone
(310) 376-9222
NPI assigned
Sep 17, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 306875 CA Primary

Addresses

Primary practice location

520 N Prospect Ave Ste 100
Redondo Beach, CA 90277-3033

Mailing address

1215 245TH St
Harbor City, CA 90710-1807
Phone (310) 626-3011

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240930000787 CA Practitioner - Physical Therapist in Private Practice 0446781678 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Touro Un Col of Osteopathic Medicine, Henderson, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Redondo Orthopedic Physical TherapyGroup PAC ID 8729382668, 14 clinicians

Practice addresses (Care Compare)

23133 Hawthorne Blvd
Suite 104
Torrance, CA 90505-3729
Phone (310) 321-4056

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
306875CAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Redondo Orthopedic Physical Therapy Physical Therapist CurrentSince Sep 19, 2024 Accepting new patients

Locations

520 N Prospect Ave
Ste 100
Redondo Beach, CA 90277
Phone (310) 376-9222

23133 Hawthorne Blvd
Ste 104
Torrance, CA 90505
Phone (310) 373-3181

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1726531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726531200000",
    "number": "1053148601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 245TH ST",
            "city": "HARBOR CITY",
            "state": "CA",
            "postal_code": "907101807",
            "telephone_number": "310-626-3011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 N PROSPECT AVE STE 100",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902773033",
            "telephone_number": "310-376-9222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CABAHUG",
        "first_name": "KYLE",
        "middle_name": "THOMAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-09-17",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "306875",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redondo Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.