Healthcare Provider Details

I. General information

NPI: 1932209624
Provider Name (Legal Business Name): HASSAN A KOBAISSI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 COLIMA RD STE A
HACIENDA HEIGHTS CA
91745-6315
US

IV. Provider business mailing address

3180 COLIMA RD STE A
HACIENDA HEIGHTS CA
91745-6315
US

V. Phone/Fax

Practice location:
  • Phone: 626-961-1882
  • Fax: 626-968-7599
Mailing address:
  • Phone: 626-961-1882
  • Fax: 626-968-7599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE4235
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: