Healthcare Provider Details

I. General information

NPI: 1457919441
Provider Name (Legal Business Name): EVANGELINE KOBAYASHI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2019
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3723 W 12600 S STE 460
RIVERTON UT
84065-7296
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-285-4650
  • Fax: 801-285-4651
Mailing address:
  • Phone:
  • Fax: 801-285-4651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number14189630-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: