Healthcare Provider Details

I. General information

NPI: 1295713410
Provider Name (Legal Business Name): MICHELLE RYOOKO KOBAYASHI DDS MSD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-1005 MOANALUA RD SUITE 847
AIEA HI
96701-4726
US

IV. Provider business mailing address

98-1005 MOANALUA RD SUITE 847
AIEA HI
96701-4726
US

V. Phone/Fax

Practice location:
  • Phone: 808-487-7933
  • Fax: 808-484-2351
Mailing address:
  • Phone: 808-487-7933
  • Fax: 808-484-2351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2046
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: