NPIMap

Individual provider Active NPI

Kimberly Ann Ebner, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Pasadena, CA
National Provider Identifier
1194119867
Registry record updated Mar 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
D37328 Issued in CA
Practice address
1060 E. Green St.
Suite 105
Pasadena, CA 91106
Phone
(626) 796-9246
Fax
(626) 564-8395
NPI assigned
Mar 20, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 20, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X D37328 CA Primary

Addresses

Primary practice location

1060 E. Green St.
Suite 105
Pasadena, CA 91106

Mailing address

1060 E. Green St.
Suite 105
Pasadena, CA 91106
Phone (626) 796-9246

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
D37328CAMDOral and Maxillofacial Surgery (Dentist)

Practice roles

OrganizationSpecialtyStatusNew patients
Kimberly a Ebner DDS Inc Oral and Maxillofacial Surgery Past Accepting new patients

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": "1426809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426809600000",
    "number": "1194119867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1060 E. GREEN ST.",
            "address_2": "SUITE 105",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "91106",
            "telephone_number": "626-796-9246",
            "fax_number": "626-564-8395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1060 E. GREEN ST.",
            "address_2": "SUITE 105",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "91106",
            "telephone_number": "626-796-9246",
            "fax_number": "626-564-8395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EBNER",
        "first_name": "KIMBERLY",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-03-20",
        "last_updated": "2015-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "D37328",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pasadena, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2015; 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.