Provider Demographics
NPI:1417459397
Name:MATTHEW A. KORN, DDS, PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MATTHEW A. KORN, DDS, PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:KORN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-447-5676
Mailing Address - Street 1:2830 G ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-3784
Mailing Address - Country:US
Mailing Address - Phone:916-446-9100
Mailing Address - Fax:
Practice Address - Street 1:2830 G ST STE 100
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-3784
Practice Address - Country:US
Practice Address - Phone:916-446-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-06
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA384381223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty