Active NPI
Kevin Shibayama
- Rehabilitation Practitioner
- Culver City, CA
National Provider Identifier
1346771292
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Practitioner
- Practice address
- 9808 Venice Blvd Ste 700
Culver City, CA 90232-6824 - Phone
- (310) 945-3350
- Fax
- (310) 945-3356
- NPI assigned
- Mar 22, 2017
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 122898 III | CA | |
| Rehabilitation Practitioner | 225400000X | Primary |
Addresses
Primary practice location
9808 Venice Blvd Ste 700
Culver City, CA 90232-6824
Mailing address
9808 Venice Blvd Ste 700
Culver City, CA 90232-6824
Phone (310) 945-3350
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 122898 III | Other | CA | CATC III |
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 |
|---|---|---|---|
| 122898 III | CA | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Los Angeles County Department of Public Health | Current | Accepting new patients |
Interoperability endpoints
- kevinshibayama-aadapinc@lacsapc.netsmartdirect.net
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.
-
- Public Health or Welfare Agency
- Alhambra, CA
- NPI 1700090834
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490140800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1545350400000",
"number": "1346771292",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9808 VENICE BLVD STE 700",
"city": "CULVER CITY",
"state": "CA",
"postal_code": "902326824",
"telephone_number": "310-945-3350",
"fax_number": "310-945-3356"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9808 VENICE BLVD STE 700",
"city": "CULVER CITY",
"state": "CA",
"postal_code": "902326824",
"telephone_number": "310-945-3350",
"fax_number": "310-945-3356"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIBAYAMA",
"first_name": "KEVIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-03-22",
"last_updated": "2018-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "122898 III",
"primary": false
},
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CATC III",
"identifier": "122898 III",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Culver City, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 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.