Healthcare Provider Details

I. General information

NPI: 1457602203
Provider Name (Legal Business Name): TRACIE MIKA KOBAYASHI PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 CLEMENT ST
SAN FRANCISCO CA
94118-2317
US

IV. Provider business mailing address

4150 CLEMENT ST
SAN FRANCISCO CA
94121-1563
US

V. Phone/Fax

Practice location:
  • Phone: 415-221-4810
  • Fax:
Mailing address:
  • Phone: 808-351-5017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRPH-0013293
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: