Provider Demographics
NPI:1710963095
Name:KOBASHI, LUIS I (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:I
Last Name:KOBASHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1310 W STEWART DR
Mailing Address - Street 2:SUITE 402
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3854
Mailing Address - Country:US
Mailing Address - Phone:714-547-5741
Mailing Address - Fax:714-547-5078
Practice Address - Street 1:1310 W STEWART DR
Practice Address - Street 2:SUITE 402
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3854
Practice Address - Country:US
Practice Address - Phone:714-547-5741
Practice Address - Fax:714-547-5078
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA21727208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A212720OtherBLUE SHIELD
CA00A217270Medicaid
CAA21727OtherBLUE CROSS
340018013OtherRAILROAD MEDICARE
CAA21727OtherBLUE CROSS
CA330800590OtherTAX ID NUMBER
CA00A217270Medicaid