Healthcare Provider Details

I. General information

NPI: 1831126424
Provider Name (Legal Business Name): JULIE KORENBERG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD.
LOS ANGELES CA
90048-1865
US

IV. Provider business mailing address

PO BOX 512717
LOS ANGELES CA
90051-0717
US

V. Phone/Fax

Practice location:
  • Phone: 310-967-1884
  • Fax: 310-967-1744
Mailing address:
  • Phone: 310-967-1884
  • Fax: 310-967-1744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA40959
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number6830076-1205
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code207SG0203X
TaxonomyClinical Molecular Genetics Physician
License Number6830076-1205
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number6830076-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: