Provider Demographics
NPI:1043236292
Name:KORDAS, KARIN C (MD)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:C
Last Name:KORDAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 262160
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92196-2160
Mailing Address - Country:US
Mailing Address - Phone:760-432-6644
Mailing Address - Fax:760-739-8213
Practice Address - Street 1:215 S HICKORY ST STE 118
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4304
Practice Address - Country:US
Practice Address - Phone:760-739-2371
Practice Address - Fax:760-739-2376
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78648207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI06853Medicare UPIN
CACB210543Medicare PIN
CAWA78648BMedicare ID - Type Unspecified