Individual provider Active NPI

Celia Elaine Kulda, O.D.

  • Optometrist
  • Los Angeles, CA
National Provider Identifier
1306991062
Registry record updated Oct 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
9304TLG Issued in CA
Practice address
11611 San Vicente Blvd Ste 500
Los Angeles, CA 90049
Phone
(310) 893-2319
NPI assigned
Jan 24, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 9304TLG CA Primary

Addresses

Primary practice location

11611 San Vicente Blvd Ste 500
Los Angeles, CA 90049

Mailing address

12460 Bay Hill CT
Garden Grove, CA 92843-4182
Phone (909) 633-0362

Other identifiers 1

IdentifierTypeStateIssuer
SD0093040MedicaidCA

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
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

LicenseStateTypeSpecialty
9304TLGCAMDOptometrist

NPI Registry JSON

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

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539043200000",
    "number": "1306991062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12460 BAY HILL CT",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928434182",
            "telephone_number": "909-633-0362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11611 SAN VICENTE BLVD STE 500",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90049",
            "telephone_number": "310-893-2319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KULDA",
        "first_name": "CELIA",
        "middle_name": "ELAINE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-24",
        "last_updated": "2018-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "9304TLG",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0093040",
            "state": "CA"
        }
    ],
    "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 9, 2018; 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.