Provider Demographics
NPI:1508329947
Name:KOR, MATTHEW JOSHUA KING-LUNG (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JOSHUA KING-LUNG
Last Name:KOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:768 MOUNTAIN RANCH RD
Mailing Address - Street 2:C/O MEDICAL STAFF OFFICE
Mailing Address - City:SAN ANDREAS
Mailing Address - State:CA
Mailing Address - Zip Code:95249-9707
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:702 MOUNTAIN RANCH RD
Practice Address - Street 2:
Practice Address - City:SAN ANDREAS
Practice Address - State:CA
Practice Address - Zip Code:95249
Practice Address - Country:US
Practice Address - Phone:092-754-4564
Practice Address - Fax:209-942-3462
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-11
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA180770207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty