Provider Demographics
NPI:1407098999
Name:RONALD T. KOBAYASHI & ASSOCIATES, PC
Entity Type:Organization
Organization Name:RONALD T. KOBAYASHI & ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRST DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:T
Authorized Official - Last Name:KOBAYASHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:671-649-7588
Mailing Address - Street 1:590 S MARINE CORPS DR STE 211
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-3532
Mailing Address - Country:US
Mailing Address - Phone:671-649-7588
Mailing Address - Fax:671-646-1088
Practice Address - Street 1:590 SOUTH MARINE CORPS DRIVE
Practice Address - Street 2:STE. 211
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-0000
Practice Address - Country:US
Practice Address - Phone:671-649-7588
Practice Address - Fax:671-646-1088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-30
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM-1025208600000X
2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000BFDBRMedicare UPIN