Provider Demographics
NPI:1477500908
Name:KOBORI, MARVIN SADAO (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:SADAO
Last Name:KOBORI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 TERRA NOVA BLVD
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-4308
Mailing Address - Country:US
Mailing Address - Phone:650-359-1463
Mailing Address - Fax:650-359-4489
Practice Address - Street 1:1031 TERRA NOVA BLVD
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-4308
Practice Address - Country:US
Practice Address - Phone:650-359-1463
Practice Address - Fax:650-359-4489
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24562122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist