Provider Demographics
NPI:1770683682
Name:WESLEY M KOBAYASHI DPM INCORPORATED
Entity Type:Organization
Organization Name:WESLEY M KOBAYASHI DPM INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOBAYASHI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:714-841-1963
Mailing Address - Street 1:18800 MAIN ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1707
Mailing Address - Country:US
Mailing Address - Phone:714-841-1963
Mailing Address - Fax:714-841-6919
Practice Address - Street 1:18800 MAIN ST
Practice Address - Street 2:SUITE 104
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1707
Practice Address - Country:US
Practice Address - Phone:714-841-1963
Practice Address - Fax:714-841-6919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ06803ZOtherB/S OF CAL. GROUP #
CA5506490001Medicare NSC