Ksenia Bubukina

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

108837 Issued in CA

Practice address

16071 Goldenwest St
Huntington Beach, CA 92647-3405

Phone

(714) 536-2383

NPI assigned

Oct 15, 2021

Reactivated

Nov 8, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

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.

• Smith and Sharifian Dental Corporation

  • Dentist
  • Huntington Beach, CA
  • NPI 1508285503
  NPD (past)

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

{
    "created_epoch": "1634256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700438400000",
    "number": "1316600430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "714 TIVERTON AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900958361"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16071 GOLDENWEST ST",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926473405",
            "telephone_number": "714-536-2383"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3290 Sawtelle Blvd Apt 203",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900661659",
            "country_code": "US",
            "telephone_number": "415-624-9906",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUBUKINA",
        "first_name": "KSENIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-15",
        "last_updated": "2023-11-20",
        "certification_date": "2023-11-20",
        "deactivation_date": "2023-10-22",
        "reactivation_date": "2023-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "108837",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UC SHIP",
            "identifier": "XDP801667280",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• William Austin Brown, DC
• Heather Browne, PSYD, LMFT
• Bruce D Appelbaum MD Inc
• Yanik Bryan
• Lindsey Bryson
• Tyler Buchholz
• Buckeye Recovery Network, LLC
• Buckeye Recovery Network, LLC
• Kayli Denae Buckingham
• Alli Budd-Vizcaino

• General Practice Dentistry in Huntington Beach, CA
• Providers in Huntington Beach, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2023; 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.