Provider Demographics
NPI:1609910710
Name:KOBILKA, BRIAN (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:KOBILKA
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 1:279 CAMPUS DR
Mailing Address - Street 2:BECKMAN CENTER ROOM 157
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-5345
Mailing Address - Country:US
Mailing Address - Phone:650-723-7069
Mailing Address - Fax:
Practice Address - Street 1:279 CAMPUS DR
Practice Address - Street 2:BECKMAN CENTER ROOM 157
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-5345
Practice Address - Country:US
Practice Address - Phone:650-723-7069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68848207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine