Provider Demographics
NPI:1922095439
Name:KOBAYASHI, KRISTINE MICHI (OD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:MICHI
Last Name:KOBAYASHI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4266 LINCOLN BLVD
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5618
Mailing Address - Country:US
Mailing Address - Phone:310-823-4595
Mailing Address - Fax:310-823-4598
Practice Address - Street 1:11245 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90606-3111
Practice Address - Country:US
Practice Address - Phone:562-692-1208
Practice Address - Fax:626-856-0570
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9444152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0094440Medicaid
CAU19255Medicare UPIN
CAWOP94444AMedicare ID - Type Unspecified