Provider Demographics
NPI:1275573446
Name:COIRIN, ANTONIO KOBYASHI (MD)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:KOBYASHI
Last Name:COIRIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1552 COFFEE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3122
Mailing Address - Country:US
Mailing Address - Phone:209-248-7168
Mailing Address - Fax:209-846-9641
Practice Address - Street 1:1552 COFFEE RD STE 200
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-3122
Practice Address - Country:US
Practice Address - Phone:209-248-7168
Practice Address - Fax:209-846-9641
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG596972086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G596971Medicaid
E50794Medicare UPIN
00G596970Medicare ID - Type Unspecified