DR. KELLY ALEXANDRA SHIMADA D.D.S.
NPI 1184075111
Dentist - Prosthodontics in Los Angeles, CA
About Dr. Kelly Alexandra Shimada D.d.s. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. KELLY ALEXANDRA SHIMADA D.D.S. (NPI 1184075111) is an individual prosthodontics provider in Los Angeles, California, licensed in California (64313) and active in the NPI registry since June 2016. She has opted out of Medicare through December 26, 2026 and remains eligible to order and refer.
NPPES Registry Identity
Specialties & Licenses
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Opted out of Medicare
Dr. Kelly Alexandra Shimada D.d.s. has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from December 26, 2018 through December 26, 2026.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 90073 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
LOS ANGELES, CA 90073
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Kelly Shimada's NPI number?
The NPI number for Kelly Shimada is 1184075111. It was assigned to this individual provider in the NPPES registry on June 30, 2016.
Where is Kelly Shimada located?
Kelly Shimada practices at 11301 Wilshire Blvd Bldg 500 Dental, Los Angeles, CA 90073. The listed phone number is (626) 399-5248.
What is Kelly Shimada's specialty?
The primary specialty registered for this NPI is Dentist, specializing in Prosthodontics, with taxonomy code 1223P0700X.
Is Kelly Shimada enrolled in Medicare?
No. Kelly Shimada has opted out of Medicare through December 26, 2026. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.
What insurance does Kelly Shimada accept?
Health plans from Ambetter Health, Ambetter of Alabama, Anthem Blue Cross and Blue Shield, BEST Life and Blue Cross and Blue Shield of Montana and 11 other insurers list Kelly Shimada as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Kelly Shimada was last updated on March 27, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Dr. Kelly Alexandra Shimada, D.D.S. · NPI 1184075111
Prosthodontics provider in Los Angeles, California. Individual provider, active in the CMS NPPES registry since June 30, 2016.
## Identity
- **NPI:** 1184075111 (Entity type: Individual)
- **Enumerated:** June 30, 2016
- **Primary specialty:** Dentist - Prosthodontics · taxonomy 1223P0700X
- **State license:** 64313 (California)
- **Sole proprietor:** No
## Practice location
- **Address:** 11301 WILSHIRE BLVD, BLDG 500 DENTAL, Los Angeles, CA 90073-1003
- **Phone:** (626) 399-5248
## Medicare
- **Medicare:** Opted out of Medicare (opt-out affidavit on file, in effect through December 26, 2026); services are provided under private contract
## Record status
- **NPPES last updated:** March 27, 2020
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Source: [NPI Profile](https://npiprofile.com/npi/1184075111) · Data from the CMS NPPES public registry.