Healthcare Provider Details

I. General information

NPI: 1962741132
Provider Name (Legal Business Name): WILLIAM MARK KORN LCSW, MSW, M.ED.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ZE'EV KORN LCSW, MSW, M.ED.

II. Dates (important events)

Enumeration Date: 02/08/2013
Last Update Date: 12/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 W JEFFERSON BLVD
LOS ANGELES CA
90018-3237
US

IV. Provider business mailing address

3501 W JEFFERSON BLVD
LOS ANGELES CA
90018-3237
US

V. Phone/Fax

Practice location:
  • Phone: 323-730-1205
  • Fax:
Mailing address:
  • Phone: 323-730-1205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS28868
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: