Healthcare Provider Details

I. General information

NPI: 1922095439
Provider Name (Legal Business Name): KRISTINE MICHI KOBAYASHI O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11245 WASHINGTON BLVD
WHITTIER CA
90606-3111
US

IV. Provider business mailing address

4266 LINCOLN BLVD
MARINA DEL REY CA
90292-5618
US

V. Phone/Fax

Practice location:
  • Phone: 562-692-1208
  • Fax: 626-856-0570
Mailing address:
  • Phone: 310-823-4595
  • Fax: 310-823-4598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number9444
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: