Kevin Tan Bibera, DDS

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

105025 Issued in CA

Practice address

875 Union Avenue Suite C211
Memphis, TN 38163-8781

Phone

(901) 448-7180

NPI assigned

Aug 26, 2020

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Old Town Dental

  • Dental Clinic/Center
  • Tehachapi, CA
  • NPI 1184257008
  NPD

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

{
    "created_epoch": "1598400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651017600000",
    "number": "1770196024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1854 CLAIRE CT",
            "city": "CONCORD",
            "state": "CA",
            "postal_code": "945192359",
            "telephone_number": "424-325-9270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 UNION AVENUE SUITE C211",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381638781",
            "telephone_number": "901-448-7180"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20406 Brian Way # 2",
            "address_purpose": "LOCATION",
            "city": "Tehachapi",
            "state": "CA",
            "postal_code": "935618781",
            "country_code": "US",
            "telephone_number": "661-822-6706",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BIBERA",
        "first_name": "KEVIN",
        "middle_name": "TAN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-26",
        "last_updated": "2022-04-27",
        "certification_date": "2022-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "105025",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CA",
            "license": "105025",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Senthil Velan Bhoopalan, MBBS, PHD
• BHW Estate
• Justin Biam, DDS
• Michael Allen Bibb, MD
• Patrice R Bibbs
• Bennett W Bicknell, MD
• Curtis Thomas Bicknell, PHARMD
• Johanna Marie Bieberly
• Dawn Michelle Bierdz, P.T.
• Adrienne N Biggers

• Student in an Organized Health Care Education/Training Program in Memphis, TN
• Providers in Memphis, TN by specialty
• Student in an Organized Health Care Education/Training Program in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2022; 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.