John S Kishibay, DMD

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

27778 Issued in CA

Practice address

2601 Ocean Park Blvd
304
Santa Monica, CA 90405-5210

Phone

(310) 581-5757

Fax

(310) 581-5759

NPI assigned

Oct 2, 2006

Last updated

Dec 4, 2012By the provider in NPPES

Sex

Male

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

Enrolled in CA

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Children's Hospital Los Angeles Medical Group, Inc.

  • Multi-Specialty Clinic/Center
  • Los Angeles, CA
  • NPI 1265530653
  Medicare reassignment NPD

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354579200000",
    "number": "1255425609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2601 OCEAN PARK BLVD",
            "address_2": "304",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904055210",
            "telephone_number": "310-581-5757",
            "fax_number": "310-581-5759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2601 OCEAN PARK BLVD",
            "address_2": "304",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904055210",
            "telephone_number": "310-581-5757",
            "fax_number": "310-581-5759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KISHIBAY",
        "first_name": "JOHN",
        "middle_name": "S",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2012-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CA",
            "license": "27778",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Kirsch, MD
• Stephen Kirsch, MCD CCC-A
• Nadine Kirshbaum
• Pamela Freundl Kirst, PH.D.
• Dina K Kiseleva, M.D.
• Beverly Kitaen-Morse, BEVERLY KITAEN-MORSE
• Nicole Michiyo Kiyohara, MD
• Noga Klain, BCBA
• Sheldon N. Klausner, M.D.
• Karen Eve Kleeman, M.D.

• Orthodontics and Dentofacial Orthopedics Dentistry in Santa Monica, CA
• Providers in Santa Monica, CA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2012; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.