Kelly Alexandra Shimada, D.D.S.

Primary specialty

ProsthodonticsTaxonomy code 1223P0700X

License

64313 Issued in CA

Practice address

11301 Wilshire Blvd
BLDG 500 Dental
Los Angeles, CA 90073-1003

Phone

(626) 399-5248

NPI assigned

Jun 30, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Dec 26, 2018 through Dec 26, 2026

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Shvartsman Shimada Dental Partnership

  • General Practice Dentistry
  • Redondo Beach, CA
  • NPI 1144993502

  Prosthodontics

  NPD Authorized official

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

{
    "created_epoch": "1467244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585267200000",
    "number": "1184075111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25078 PEACHLAND AVE STE H",
            "city": "NEWHALL",
            "state": "CA",
            "postal_code": "913212555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11301 WILSHIRE BLVD",
            "address_2": "BLDG 500 DENTAL",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900731003",
            "telephone_number": "626-399-5248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIMADA",
        "first_name": "KELLY",
        "middle_name": "ALEXANDRA",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-30",
        "last_updated": "2020-03-27",
        "certification_date": "2020-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "CA",
            "license": "64313",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shiloh Family Pharmacy,Inc.
• Shiloh Gog Ministries
• Albert Lee Shim, MD
• Jae Rock Shim, CRNA
• Joomee Shim
• Marianna Shiman
• Peter Shimizu, DDS
• Stephanie Ann Shimizu, DDS
• Tota Shimizu, DDS
• Miriam Hanna Shimoni, M.S. SLP-CFY

• Prosthodontics in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Prosthodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.