Healthcare Provider Details

I. General information

NPI: 1801097365
Provider Name (Legal Business Name): AI LAN D. KOBAYASHI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E GOLD COAST RD SUITE 325
PAPILLION NE
68046-4194
US

IV. Provider business mailing address

401 E GOLD COAST RD SUITE 325
PAPILLION NE
68046-4194
US

V. Phone/Fax

Practice location:
  • Phone: 402-592-1700
  • Fax: 402-592-3335
Mailing address:
  • Phone: 402-592-1700
  • Fax: 402-592-3335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number15261
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: