Individual provider Active NPI

Allen R Kubko, FNP-C

  • Family Nurse Practitioner
  • Santa Monica, CA
National Provider Identifier
1780550624
Registry record updated Oct 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95032650 Issued in CA
Practice address
2021 Santa Monica Blvd Ste 424E
Santa Monica, CA 90404-2151
Phone
(310) 590-7020
Fax
(310) 310-2724
NPI assigned
Oct 16, 2025
Last updated
Oct 24, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 24, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95032650 CA Primary

Addresses

Primary practice location

2021 Santa Monica Blvd Ste 424E
Santa Monica, CA 90404-2151

Mailing address

2021 Santa Monica Blvd Ste 424E
Santa Monica, CA 90404-2151
Phone (310) 590-7020

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260319003507 CA Practitioner - Nurse Practitioner 9234616178 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Dennis Stolpner MD IncGroup PAC ID 9335594464, 2 clinicians

Practice addresses (Care Compare)

2021 Santa Monica Blvd
Suite 440E
Santa Monica, CA 90404-2154
Phone (310) 453-1386

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
95032650CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Dennis Stolpner MD Inc Multi-Specialty CurrentSince Dec 29, 2025 Accepting new patients
Saint John's Health Clinic Multi-Specialty PastSince Oct 21, 2025 Accepting new patients
Providence Saint Johns Medical Foundation Multi-Specialty PastSince Oct 21, 2025 Accepting new patients

Locations

2021 Santa Monica Blvd
Ste 440E
Santa Monica, CA 90404
Phone (310) 453-1386

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1760572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761264000000",
    "number": "1780550624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2021 SANTA MONICA BLVD STE 424E",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904042151",
            "telephone_number": "310-590-7020",
            "fax_number": "310-310-2724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2021 SANTA MONICA BLVD STE 424E",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904042151",
            "telephone_number": "310-590-7020",
            "fax_number": "310-310-2724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUBKO",
        "first_name": "ALLEN",
        "middle_name": "R",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-10-16",
        "last_updated": "2025-10-24",
        "certification_date": "2025-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95032650",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Monica, CA

Sources for this page

Verify at the official NPI Registry.