Healthcare Provider Details

I. General information

NPI: 1700962727
Provider Name (Legal Business Name): KENNETH JOSEPH TOBIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 1ST ST W STE L
SONOMA CA
95476-7046
US

IV. Provider business mailing address

651 1ST ST W STE L
SONOMA CA
95476-7046
US

V. Phone/Fax

Practice location:
  • Phone: 707-935-1470
  • Fax:
Mailing address:
  • Phone: 707-935-1470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number5101011720
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25035
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101011720
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: