Basic Information
| Provider Information | |||||||||
| NPI: | 1265902555 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KOBAYASHI | ||||||||
| FirstName: | LIANA | ||||||||
| MiddleName: | TSURUKO | ||||||||
| NamePrefix: | |||||||||
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| Credential: | DO, MPH | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 98-1005 MOANALUA RD SPC 3030 | ||||||||
| Address2: | |||||||||
| City: | AIEA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967014735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086273200 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 98-1005 MOANALUA RD SPC 3030 | ||||||||
| Address2: | |||||||||
| City: | AIEA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967014735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8086273200 | ||||||||
| FaxNumber: | 8086237872 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2018 | ||||||||
| LastUpdateDate: | 07/08/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 05/30/2020 | ||||||||
| NPIReactivationDate: | 07/08/2020 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | DOSR-503 | HI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.