Healthcare Provider Details

I. General information

NPI: 1588738678
Provider Name (Legal Business Name): STEPHEN AKIRA KOBAYASHI MD GENERAL SURGEON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 PIONEER LANE SUITE F
BISHOP CA
93514
US

IV. Provider business mailing address

152 PIONEER LANE SUITE F
BISHOP CA
93514
US

V. Phone/Fax

Practice location:
  • Phone: 760-873-3503
  • Fax: 760-873-7544
Mailing address:
  • Phone: 760-873-3503
  • Fax: 760-873-7544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA222090
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: