Ebony Jordan, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DDS103462 Issued in CA

Practice address

1427 Mission St
South Pasadena, CA 91030-3213

Phone

(626) 403-1800

NPI assigned

Jul 27, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

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

Practice roles

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.

• Encino Surgical Center LLC

  • Ambulatory Surgical Clinic/Center
  • Encino, CA
  • NPI 1316342579
  NPD (past)

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

{
    "created_epoch": "1280188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712188800000",
    "number": "1891009346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1427 MISSION ST",
            "city": "SOUTH PASADENA",
            "state": "CA",
            "postal_code": "910303213",
            "telephone_number": "626-669-4655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1427 MISSION ST",
            "city": "SOUTH PASADENA",
            "state": "CA",
            "postal_code": "910303213",
            "telephone_number": "626-403-1800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORDAN",
        "first_name": "EBONY",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-27",
        "last_updated": "2024-04-04",
        "certification_date": "2024-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "IN",
            "license": "12012022A",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "DDS103462",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12012022A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristy Amee Johnson
• Maria Cavanagh Johnson, PH.D.
• Vivian Johnson, LMFT
• Myrna B Johnston, LVN
• Christopher Koon Sing Jong, M.D.
• Joseph Anthony Aldana Chiropractic
• Joseph M Molina MD Professional Corporation- Southern California
• Katie Elaine Joseph
• Joyee Acupuncture & Herbs
• Ariana Julian

• Pediatric Dentistry in South Pasadena, CA
• Providers in South Pasadena, CA by specialty
• Pediatric Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 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.