JOHN S KISHIBAY DMD
NPI 1255425609
Dentist - Orthodontics and Dentofacial Orthopedics in Santa Monica, CA

Active since October 02, 2006PECOS Enrolled
2601 OCEAN PARK BLVD, 304, SANTA MONICA, CA 90405(310) 581-5757(310) 581-5759 Get Directions Write a Review

NPPES record last updated: December 4, 2012. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About John S Kishibay Dmd NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JOHN S KISHIBAY DMD (NPI 1255425609) is an individual orthodontics and dentofacial orthopedics provider in Santa Monica, California, licensed in California (27778) and active in the NPI registry since October 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1255425609
Entity TypeIndividualMale
Primary Taxonomy1223X0400X
Provider Legal NameJOHN S KISHIBAYCredential: DMD
Location Address2601 OCEAN PARK BLVD, 304Santa Monica, CA 90405-5210
Mailing Address2601 Ocean Park Blvd, 304Santa Monica, CA 90405-5210 · (310) 581-5757 · Fax (310) 581-5759
Fax(310) 581-5759
Sole ProprietorNo
Enumeration DateOctober 2, 2006
Last NPPES UpdateDecember 4, 2012
✔ NPI 1255425609 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Orthodontics and Dentofacial OrthopedicsDental Providers
Taxonomy Code1223X0400X
License✔ Licensed in CA · 27778
Definition
That area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of functional forces within the craniofacial complex. Major responsibilities of orthodontic practice include the diagnosis, prevention, interception and treatment of all forms of malocclusion of the teeth and associated alterations in their surrounding structures; the design, application and control of functional and corrective appliances; and the guidance of the dentition and its supporting structures to attain and maintain optimum occlusal relations in physiologic and esthetic harmony among facial and cranial structures.
2601 OCEAN PARK BLVD, Santa Monica, CA 90405

Other Identifiers 2

Medicare ID-Type UnspecifiedWD27778CA
Medicare UPINU36417CA

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

John S Kishibay Dmd is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show John Kishibay reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Multi-Specialty
4650 SUNSET BLVD
Los Angeles, CA 90027
  • Reassigned Medicare billing, California enrollment
  • Medicare enrollment name: Childrens Hospital Los Angeles Medical Group Inc
  • 1,281 clinicians in this Medicare group

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 90405 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$96.36 typical visit price
range $62.96 – $187.60
Typical copayment $24.09 (range $15.74 – $46.90)
Most-billed visit code 99203
Established Patient
$77.96 typical visit price
range $20.84 – $153.61
Typical copayment $19.49 (range $5.21 – $38.40)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Physical Therapist
2601 OCEAN PARK BLVD, STE 302
SANTA MONICA, CA 90405
Specialist/Technologist, Other (Electroneurodiagnostic)
2601 OCEAN PARK BLVD, SUITE 100
SANTA MONICA, CA 90405
Dentist (Orthodontics and Dentofacial Orthopedics)
2601 OCEAN PARK BLVD, SUITE 304
SANTA MONICA, CA 90405

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 John Kishibay's NPI number?

The NPI number for John Kishibay is 1255425609. It was assigned to this individual provider in the NPPES registry on October 2, 2006.

Where is John Kishibay located?

John Kishibay practices at 2601 Ocean Park Blvd 304, Santa Monica, CA 90405. The listed phone number is (310) 581-5757.

What is John Kishibay's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Orthodontics and Dentofacial Orthopedics, with taxonomy code 1223X0400X.

Is John Kishibay enrolled in Medicare?

Yes. John Kishibay is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for John Kishibay's services?

According to the CMS Revalidation Reassignment List (October 2026 release), John Kishibay reassigns Medicare benefits to Children's Hospital Los Angeles Medical Group, Inc. (Los Angeles, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for John Kishibay's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does John Kishibay accept?

Health plans from Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and Humana list John Kishibay 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 John Kishibay was last updated on December 4, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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.