Samuel Kibara, APRN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

95396611 Issued in CA

Practice address

961 E Phillips Blvd Unit 3
Pomona, CA 91766-7553

Phone

(972) 207-1080

NPI assigned

May 8, 2023

Last updated

Dec 22, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

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

{
    "created_epoch": "1683504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734825600000",
    "number": "1932898657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "961 E PHILLIPS BLVD UNIT 3",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917667553",
            "telephone_number": "972-207-1080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "961 E PHILLIPS BLVD UNIT 3",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917667553",
            "telephone_number": "972-207-1080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIBARA",
        "first_name": "SAMUEL",
        "name_prefix": "Mr.",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-05-08",
        "last_updated": "2024-12-22",
        "certification_date": "2024-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95396611",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "TX",
            "license": "1117621",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ali Khosravi, DO
• Lara Khosrovian
• Mohammad Khoudari
• Tabitha W Kiama
• Maureen Nyambura Kibara
• Mandi Moxie Kibel
• Kihun Sung D.D.S. Inc.
• Ivory Noelle Killion, BCBA
• Adam Kim
• Alina Kim

• Registered Nurse in Pomona, CA
• Providers in Pomona, CA by specialty
• Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2024; 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.