Active NPI
Kevin J Cebula, D.D.S.
- Orofacial Pain Dentistry
- Pasadena, CA
National Provider Identifier
1962464040
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orofacial Pain Dentistry
- License
- 64314
- Practice address
- 301 S Fair Oaks Ave
Ste 402
Pasadena, CA 91105-2562 - Phone
- (626) 658-9004
- Fax
- (626) 658-9034
- NPI assigned
- Apr 4, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orofacial Pain Dentistry | 1223X2210X | 64314 | CA | Primary |
Addresses
Primary practice location
301 S Fair Oaks Ave
Ste 402
Pasadena, CA 91105-2562
Mailing address
301 S Fair Oaks Ave
Ste 402
Pasadena, CA 91105-2562
Phone (626) 658-9004
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 7, 2020 through Jan 7, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 64314 | CA | MD | Orofacial Pain Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144108800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1581552000000",
"number": "1962464040",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 S FAIR OAKS AVE",
"address_2": "STE 402",
"city": "PASADENA",
"state": "CA",
"postal_code": "911052562",
"telephone_number": "626-658-9004",
"fax_number": "626-658-9034"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 S FAIR OAKS AVE",
"address_2": "STE 402",
"city": "PASADENA",
"state": "CA",
"postal_code": "911052562",
"telephone_number": "626-658-9004",
"fax_number": "626-658-9034"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CEBULA",
"first_name": "KEVIN",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-04",
"last_updated": "2020-02-13",
"certification_date": "2020-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223X2210X",
"taxonomy_group": "",
"desc": "Dentist, Orofacial Pain",
"state": "CA",
"license": "64314",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pasadena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.