Healthcare Provider Details

I. General information

NPI: 1790869196
Provider Name (Legal Business Name): RICHARD JOHN KOCHENBURGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 WHITEHALL PL SUITE A
ALAMEDA CA
94501-6160
US

IV. Provider business mailing address

2111 WHITEHALL PL SUITE A
ALAMEDA CA
94501-6160
US

V. Phone/Fax

Practice location:
  • Phone: 510-522-6544
  • Fax: 510-522-3600
Mailing address:
  • Phone: 510-522-6544
  • Fax: 510-522-3600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG0692540
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: