Healthcare Provider Details

I. General information

NPI: 1679467229
Provider Name (Legal Business Name): RYAN MATTHEW KOBAYASHI OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5750 DOWNEY AVE
LAKEWOOD CA
90712-1405
US

IV. Provider business mailing address

2237 VIA GUADALANA
PALOS VERDES ESTATES CA
90274-1617
US

V. Phone/Fax

Practice location:
  • Phone: 310-575-0564
  • Fax:
Mailing address:
  • Phone: 310-594-0360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number36362
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: