Provider Demographics
NPI:1053464347
Name:KOR, JOSEPH T (DMD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:T
Last Name:KOR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 S SAN GABRIEL BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3975
Mailing Address - Country:US
Mailing Address - Phone:626-288-9055
Mailing Address - Fax:626-288-2334
Practice Address - Street 1:1720 S SAN GABRIEL BLVD STE 101
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3975
Practice Address - Country:US
Practice Address - Phone:626-288-9055
Practice Address - Fax:626-288-2334
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37126122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist