Healthcare Provider Details

I. General information

NPI: 1235220021
Provider Name (Legal Business Name): DON KAROU KOBASHIGAWA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 06/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4405 W RIVERSIDE DR STE 300
BURBANK CA
91505-4072
US

IV. Provider business mailing address

4405 W RIVERSIDE DR STE 300
BURBANK CA
91505-4072
US

V. Phone/Fax

Practice location:
  • Phone: 818-846-3831
  • Fax: 818-846-2348
Mailing address:
  • Phone: 818-846-3831
  • Fax: 818-846-2348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number28741
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: