Healthcare Provider Details

I. General information

NPI: 1184900037
Provider Name (Legal Business Name): KOBAYASHI OPTOMETRIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2011
Last Update Date: 02/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13161 MINDANAO WAY # D6A
MARINA DEL REY CA
90292-6307
US

IV. Provider business mailing address

13161 MINDANAO WAY # D6A
MARINA DEL REY CA
90292-6307
US

V. Phone/Fax

Practice location:
  • Phone: 310-823-4595
  • Fax:
Mailing address:
  • Phone: 310-823-4595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number9444T
License Number StateCA

VIII. Authorized Official

Name: DR. KRISTINE KOBAYASHI
Title or Position: PRESIDENT
Credential: OD
Phone: 310-823-4595