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General NPI Number Information
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NPI Number | 1922803071
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Entity Type | Individual
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Provider Name | JAACE KOREERAT
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Gender | Male
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Dates
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Enumeration Date | 02/13/2025
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 140 W GUINIDA LN
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City | ANAHEIM
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State | CA
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Zip | 92805-6101
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Country | US
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Telephone | 714-517-8950
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Fax |
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Provider Business Mailing Address
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Address Line | 1931 PAGE AVE
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City | FULLERTON
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State | CA
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Zip | 92833-4435
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Country | US
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Telephone |
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Fax |
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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 | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 110757
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License Number State | CA
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