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General NPI Number Information
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NPI Number | 1780761692
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Entity Type | Individual
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Provider Name | VEENA JACOB KORAH M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 2057 GREEN BAY RD # 1001
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-6101
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Country | US
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Telephone | 708-320-1477
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Fax | 207-881-4056
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Provider Business Mailing Address
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Address Line | 401 WARREN ST STE 300
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City | REDWOOD CITY
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State | CA
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Zip | 94063-1536
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Country | US
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Telephone | 708-320-1477
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Fax | 207-881-4056
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036113959
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License Number State | IL
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