Healthcare Provider Details

I. General information

NPI: 1083118616
Provider Name (Legal Business Name): JOSEPH ERIC KORESSEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 S MAIN ST STE 200
ORANGE CA
92868-3852
US

IV. Provider business mailing address

280 S MAIN ST STE 200
ORANGE CA
92868-3852
US

V. Phone/Fax

Practice location:
  • Phone: 714-634-4567
  • Fax:
Mailing address:
  • Phone: 714-634-4567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA185816
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberA185816
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: