Provider Demographics
NPI:1790869196
Name:KOCHENBURGER, RICHARD JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JOHN
Last Name:KOCHENBURGER
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 1:2111 WHITEHALL PL
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-6160
Mailing Address - Country:US
Mailing Address - Phone:510-522-6544
Mailing Address - Fax:510-522-3600
Practice Address - Street 1:2111 WHITEHALL PL
Practice Address - Street 2:SUITE A
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-6160
Practice Address - Country:US
Practice Address - Phone:510-522-6544
Practice Address - Fax:510-522-3600
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG0692540174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist