Healthcare Provider Details

I. General information

NPI: 1871582023
Provider Name (Legal Business Name): TODD T KOBAYASHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 MEDICAL CENTER POINT
COLORADO SPRINGS CO
80907
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 719-635-5148
  • Fax: 719-667-4155
Mailing address:
  • Phone: 719-463-5600
  • Fax: 719-538-2990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number01047264A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberMD214761
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberDR.0055860
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: