1417122722 NPI number — JAMES R. KORB II, D.D.S.

Table of content: DR. KATIE LEE SHORT D.C. (NPI 1902045636)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417122722 NPI number — JAMES R. KORB II, D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES R. KORB II, D.D.S.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417122722
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
355 PLACENTIA AVE
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
NEWPORT BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92663-3311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-650-2334
Provider Business Mailing Address Fax Number:
949-722-1461

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
355 PLACENTIA AVE
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
NEWPORT BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92663-3311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-650-2334
Provider Business Practice Location Address Fax Number:
949-722-1461
Provider Enumeration Date:
04/28/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KORB
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
RICHARD
Authorized Official Title or Position:
GENERAL DENTIST
Authorized Official Telephone Number:
949-650-2334

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  19918 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)