Active NPI
Chad Kiyoshi Ebesutani
- Clinical Psychologist
- Los Angeles, CA
National Provider Identifier
1215186556
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- H00715964
- Practice address
- 1000 Veteran Ave
Los Angeles, CA 90024-2704 - Phone
- (310) 825-3301
- NPI assigned
- Sep 11, 2008
- Last updated
- Oct 2, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | H00715964 | HI | Primary |
Addresses
Primary practice location
1000 Veteran Ave
Los Angeles, CA 90024-2704
Mailing address
PO Box 951563
Los Angeles, CA 90095-1563
Phone (310) 825-3301
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
| License | State | Type | Specialty |
|---|---|---|---|
| H00715964 | HI | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1221091200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1254441600000",
"number": "1215186556",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 951563",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900951563",
"telephone_number": "310-825-3301"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 VETERAN AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900242704",
"telephone_number": "310-825-3301"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EBESUTANI",
"first_name": "CHAD",
"middle_name": "KIYOSHI",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-09-11",
"last_updated": "2009-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "HI",
"license": "H00715964",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.