Provider Demographics
NPI:1932209624
Name:KOBAISSI, HASSAN A (DPM)
Entity type:Individual
Prefix:
First Name:HASSAN
Middle Name:A
Last Name:KOBAISSI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3180 COLIMA RD STE A
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-6315
Mailing Address - Country:US
Mailing Address - Phone:626-961-1882
Mailing Address - Fax:626-968-7599
Practice Address - Street 1:3180 COLIMA RD STE A
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-6315
Practice Address - Country:US
Practice Address - Phone:626-961-1882
Practice Address - Fax:626-968-7599
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4235213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU85485Medicare UPIN
E4235BMedicare ID - Type Unspecified