MEDICARE: DR. IJENDU PEACE KORIE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician	A170427	CA
2	2084P0800X	Psychiatry Physician	170427	CA

General Provider Information

NPI Number	:	1568826410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IJENDU PEACE KORIE M.D.

Provider Business Mailing Address
First Line	:	25050 PEACHLAND AVE STE 170
Second Line	:
City	:	SANTA CLARITA
State	:	CA
Zip	:	91321-2523
Country	:	US
Telephone Number	:	661-506-0607
Fax Number	:

Provider Business Practice Location Address
First Line	:	25050 PEACHLAND AVE STE 170
Second Line	:
City	:	SANTA CLARITA
State	:	CA
Zip	:	91321-2523
Country	:	US
Telephone Number	:	661-506-0607
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2016
Last Update Date	:	09/25/2025

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