Healthcare Provider Details

I. General information

NPI: 1174551006
Provider Name (Legal Business Name): BOBBY S. KORN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 03/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 GILMAN DR MAIL CODE 0946
LA JOLLA CA
92093-5004
US

IV. Provider business mailing address

PO BOX 232410 MAIL CODE 0946
SAN DIEGO CA
92193-2410
US

V. Phone/Fax

Practice location:
  • Phone: 858-534-7402
  • Fax:
Mailing address:
  • Phone: 858-249-6748
  • Fax: 619-543-3183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA81749
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: