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General NPI Number Information
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NPI Number | 1114581881
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Entity Type | Organization
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Legal Business Name | MICHAEL KOBAYASHI, OD PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 04/27/2019
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Last Update Date | 04/27/2019
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Provider Practice Location Address
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Address Line | 18204 S WESTERN AVE
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City | GARDENA
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State | CA
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Zip | 90248-3819
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Country | US
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Telephone | 310-719-2020
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Fax | 310-719-2068
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Provider Business Mailing Address
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Address Line | 18204 S WESTERN AVE
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City | GARDENA
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State | CA
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Zip | 90248-3819
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Country | US
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Telephone | 310-719-2020
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Fax | 310-719-2068
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Authorized Official
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Title or Position | CEO
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Name | DR. MICHAEL K KOBAYASHI
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Credential | OD
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Telephone | 310-766-4510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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