Jeffrey Shibata

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

1619615929 Issued in CA

Practice address

222 S Central Ave Apt 415
Los Angeles, CA 90012-4235

Phone

(805) 506-5333

NPI assigned

May 25, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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: Yes
• 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": "1653436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731628800000",
    "number": "1619615929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 S CENTRAL AVE APT 415",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900124235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 S CENTRAL AVE APT 415",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900124235",
            "telephone_number": "805-506-5333"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12021 Wilmington Ave",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900593019",
            "country_code": "US",
            "telephone_number": "424-338-8714",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHIBATA",
        "first_name": "JEFFREY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-05-25",
        "last_updated": "2024-11-15",
        "certification_date": "2024-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "1619615929",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen M Shiba, P.T.
• Jean Shibasaki, NP
• Alexander Shibata, LCSW
• Darryl Kenji Shibata, MD
• Emily Sun Shibata, DPM
• Seiji Bruce Shibata, M.D. PH.D.
• Vivian Phan Shibayama, O.D.
• Justin Shibel, ATC
• Shidban Dialysis Access Inc
• Hamid Shidban, MD

• General Practice Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2024; 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.