Healthcare Provider Details

I. General information

NPI: 1275573446
Provider Name (Legal Business Name): ANTONIO KOBYASHI COIRIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SYLVAN AVE STE A
MODESTO CA
95350-1699
US

IV. Provider business mailing address

1001 SYLVAN AVE STE A
MODESTO CA
95350-1699
US

V. Phone/Fax

Practice location:
  • Phone: 209-422-6120
  • Fax:
Mailing address:
  • Phone: 209-248-7168
  • Fax: 209-846-9641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberG59697
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: