Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kenji Shibata, DO

Individual provider Family Medicine Physician · NPI 1790844371

Kenji Shibata, DO is a Family Practice in Fontana, California. Qualified in 2002, 24 years ago. Practices with Southern California Permanente Medical Group, an 11,242-clinician group, accepts Medicare assignment and offers telehealth. Licensed in California.

Years since qualifying
24
Licensed in
CA
In the registry since
2006
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

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Practice location Address checks out

9961 Sierra Ave
Fontana, CA 92335-6720
Phone: (909) 427-3910
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 20A8912 (CA)

Record details

NPI number1790844371
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorNo
NPI enumeratedDecember 8, 2006
Last updated in NPPESNovember 30, 2021
Mailing address9961 Sierra Ave, Fontana, CA 92335-6720

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolOTHER
Graduated 2002 (24 years in practice)
Group practice Southern California Permanente Medical Group — 11242 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

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