Provider Demographics
NPI:1295942696
Name:L I KOBASHI, MD, INC
Entity type:Organization
Organization Name:L I KOBASHI, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:I
Authorized Official - Last Name:KOBASHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-547-5741
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA21727208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A217270Medicaid
CAA22744Medicare UPIN
CA00A217270Medicaid