Provider Demographics
NPI:1164719498
Name:KORB, DAMON RUSSELL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAMON
Middle Name:RUSSELL
Last Name:KORB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15951 LOS GATOS BLVD
Mailing Address - Street 2:ST. 6
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-3428
Mailing Address - Country:US
Mailing Address - Phone:408-358-1853
Mailing Address - Fax:408-358-1802
Practice Address - Street 1:15951 LOS GATOS BLVD
Practice Address - Street 2:ST. 6
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-3428
Practice Address - Country:US
Practice Address - Phone:408-358-1853
Practice Address - Fax:408-358-1802
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62686208000000X, 2080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics