Healthcare Provider Details

I. General information

NPI: 1265170476
Provider Name (Legal Business Name): PRIMARY DIAGNOSTICS MEDICAL GROUP OF KANSAS P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2022
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 OSGOOD PL STE 500
SAN FRANCISCO CA
94133-4629
US

IV. Provider business mailing address

595 PACIFIC AVE FL 4
SAN FRANCISCO CA
94133-4685
US

V. Phone/Fax

Practice location:
  • Phone: 415-746-9639
  • Fax:
Mailing address:
  • Phone: 855-907-3223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ANDREW KOBYLINSKI
Title or Position: CEO
Credential:
Phone: 415-746-9639