MEDICARE: CAROLYN LEI-TINA KOR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD-21662	HI
2	207Q00000X	Family Medicine Physician	MT211813	PA
3	207Q00000X	Family Medicine Physician	2022-03315	NC
4	208M00000X	Hospitalist Physician	036179819	IL

General Provider Information

NPI Number	:	1972952471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN LEI-TINA KOR MD

Provider Business Mailing Address
First Line	:	449 KAPAHULU AVE STE 104
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96815-3850
Country	:	US
Telephone Number	:	814-452-5105
Fax Number	:

Provider Business Practice Location Address
First Line	:	449 KAPAHULU AVE
Second Line	:	STE 104
City	:	HONOLULU
State	:	HI
Zip	:	96815-3850
Country	:	US
Telephone Number	:	814-452-5105
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2016
Last Update Date	:	05/04/2026

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