Provider Demographics
NPI:1750353496
Name:KOBAYASHI, MICHAEL K (OD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:K
Last Name:KOBAYASHI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27830 BRADLEY RD
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92586-2201
Mailing Address - Country:US
Mailing Address - Phone:951-672-4971
Mailing Address - Fax:951-672-4083
Practice Address - Street 1:27830 BRADLEY RD
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:CA
Practice Address - Zip Code:92586-2201
Practice Address - Country:US
Practice Address - Phone:951-672-4971
Practice Address - Fax:951-672-4083
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 11070T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ81412ZMedicaid
9V14069OtherIEHP
CA9V13134OtherI.E.H.P.
CAU98471Medicare UPIN
CAZZZ81412ZMedicaid