Healthcare Provider Details

I. General information

NPI: 1457073306
Provider Name (Legal Business Name): DR. NATHAN KOREIE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8578 SANTA MONICA BLVD
WEST HOLLYWOOD CA
90069-4119
US

IV. Provider business mailing address

PO BOX 571360
TARZANA CA
91357-1360
US

V. Phone/Fax

Practice location:
  • Phone: 310-289-1125
  • Fax: 310-289-0744
Mailing address:
  • Phone: 818-903-8646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number86177
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: