Healthcare Provider Details

I. General information

NPI: 1609910710
Provider Name (Legal Business Name): BRIAN KOBILKA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 CAMPUS DR BECKMAN CENTER ROOM 157
STANFORD CA
94305-5345
US

IV. Provider business mailing address

279 CAMPUS DR BECKMAN CENTER ROOM 157
STANFORD CA
94305-5345
US

V. Phone/Fax

Practice location:
  • Phone: 650-723-7069
  • Fax:
Mailing address:
  • Phone: 650-723-7069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG68848
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: