Kevin Shigeru Omoto, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

58854 Issued in CA

Practice address

15355 Brookhurst St
#101
Westminster, CA 92683-7077

Phone

(714) 531-5175

NPI assigned

Oct 27, 2010

Last updated

Oct 27, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

State licenses

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

{
    "created_epoch": "1288137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1288137600000",
    "number": "1609176460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "243 E SANTA FE CT",
            "city": "PLACENTIA",
            "state": "CA",
            "postal_code": "928706002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15355 BROOKHURST ST",
            "address_2": "#101",
            "city": "WESTMINSTER",
            "state": "CA",
            "postal_code": "926837077",
            "telephone_number": "714-531-5175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OMOTO",
        "first_name": "KEVIN",
        "middle_name": "SHIGERU",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-10-27",
        "last_updated": "2010-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "58854",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Phuong Mai Ong
• Boniface O Onubah, M.D.

• Dentist in Westminster, CA
• Providers in Westminster, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2010; 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.