NPIMap

Individual provider Active NPI

Kevin M. Kinback, M.D.

  • Psychiatry Physician
  • Ladera Ranch, CA
National Provider Identifier
1902014780
Registry record updated Feb 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
G77412 Issued in CA
Practice address
333 Corporate Dr Ste 260
Ladera Ranch, CA 92694-2180
Phone
(949) 768-2988
Fax
(949) 768-2980
NPI assigned
May 18, 2007
Last updated
Feb 13, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 13, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X G77412 CA Primary
Geriatric Psychiatry Physician 2084P0805X G77412 CA

Addresses

Primary practice location

333 Corporate Dr Ste 260
Ladera Ranch, CA 92694-2180

Mailing address

PO Box 7450
Laguna Niguel, CA 92607-7450
Phone (949) 768-2988

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060410000618 CA Practitioner - Psychiatry 6305855925 Receives reassigned benefits from 17 practitioners
Practice locations: Ladera Ranch, CA

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Loma Linda University School of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

333 Corporate Dr
Suite 260
Ladera Ranch, CA 92694-2180
Phone (949) 768-2988

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G77412CAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kevin Kinback Psychiatry CurrentSince Jan 13, 2014 Accepting new patients

Locations

333 Corporate Dr
Ste 260
Ladera Ranch, CA 92694
Phone (949) 456-4265

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

Organizations & group practices 1

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": "1179446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707782400000",
    "number": "1902014780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7450",
            "city": "LAGUNA NIGUEL",
            "state": "CA",
            "postal_code": "926077450",
            "telephone_number": "949-768-2988",
            "fax_number": "949-768-2980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 CORPORATE DR STE 260",
            "city": "LADERA RANCH",
            "state": "CA",
            "postal_code": "926942180",
            "telephone_number": "949-768-2988",
            "fax_number": "949-768-2980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KINBACK",
        "first_name": "KEVIN",
        "middle_name": "M.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-18",
        "last_updated": "2024-02-13",
        "certification_date": "2024-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "G77412",
            "primary": true
        },
        {
            "code": "2084P0805X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "CA",
            "license": "G77412",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ladera Ranch, CA

Sources for this page

Verify at the official NPI Registry.