Healthcare Provider Details

I. General information

NPI: 1629906078
Provider Name (Legal Business Name): SAMUEL KORI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 N ROSE DR
PLACENTIA CA
92870-7520
US

IV. Provider business mailing address

1027 LA MARILLO CIR
CORONA CA
92879-8234
US

V. Phone/Fax

Practice location:
  • Phone: 714-524-6200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number92222
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: