Healthcare Provider Details

I. General information

NPI: 1407098999
Provider Name (Legal Business Name): RONALD T. KOBAYASHI & ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2009
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 SOUTH MARINE CORPS DRIVE STE. 211
TAMUNING GU
96913-0000
US

IV. Provider business mailing address

590 S MARINE CORPS DR STE 211
TAMUNING GU
96913-3532
US

V. Phone/Fax

Practice location:
  • Phone: 671-649-7588
  • Fax: 671-646-1088
Mailing address:
  • Phone: 671-649-7588
  • Fax: 671-646-1088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberM-1025
License Number StateGU
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: RONALD T. KOBAYASHI
Title or Position: FIRST DIRECTOR
Credential: M.D.
Phone: 671-649-7588