Healthcare Provider Details

I. General information

NPI: 1467548073
Provider Name (Legal Business Name): JON A KOBASHIGAWA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 S SAN VICENTE BLVD # A3107
LOS ANGELES CA
90048
US

IV. Provider business mailing address

127 S SAN VICENTE BLVD # A3107
LOS ANGELES CA
90048-3311
US

V. Phone/Fax

Practice location:
  • Phone: 310-248-3830
  • Fax: 310-248-8338
Mailing address:
  • Phone: 310-248-3830
  • Fax: 310-248-8338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG045447
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG045447
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License NumberG45447
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: