Healthcare Provider Details

I. General information

NPI: 1639835721
Provider Name (Legal Business Name): MASATO KOBAYASHI DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2021
Last Update Date: 11/12/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 LAWRENCE RD
ALAMEDA CA
94502-7743
US

IV. Provider business mailing address

22 LAWRENCE RD
ALAMEDA CA
94502-7743
US

V. Phone/Fax

Practice location:
  • Phone: 619-577-2331
  • Fax:
Mailing address:
  • Phone: 619-577-2331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number300936
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: