Provider Demographics
NPI:1104975689
Name:KOBAYASHI, RONALD T (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:T
Last Name:KOBAYASHI
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:590 SOUTH MARINE CORPS DRIVE
Mailing Address - Street 2:GITC BIULDING STE 211
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913
Mailing Address - Country:US
Mailing Address - Phone:671-649-7588
Mailing Address - Fax:671-646-1088
Practice Address - Street 1:590 SOUTH MARINE CORPS DRIVE
Practice Address - Street 2:GITC BIULDING STE 211
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913
Practice Address - Country:US
Practice Address - Phone:671-649-7588
Practice Address - Fax:671-646-1088
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2014-02-18
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Provider Licenses
StateLicense IDTaxonomies
GUM001025208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000BFDBRMedicare UPIN