Provider Demographics
NPI:1457099640
Name:PRIMARY DIAGNOSTICS MEDICAL GROUP P.A.
Entity type:Organization
Organization Name:PRIMARY DIAGNOSTICS MEDICAL GROUP P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:KOBYLINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-746-9639
Mailing Address - Street 1:595 PACIFIC AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133-4685
Mailing Address - Country:US
Mailing Address - Phone:855-870-3223
Mailing Address - Fax:
Practice Address - Street 1:99 OSGOOD PL STE 500
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-4629
Practice Address - Country:US
Practice Address - Phone:415-746-9639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-26
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No333600000XSuppliersPharmacyGroup - Single Specialty
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy