Provider Demographics
NPI:1588634513
Name:KORSAND, SID (MD)
Entity Type:Individual
Prefix:
First Name:SID
Middle Name:
Last Name:KORSAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SAEID
Other - Middle Name:
Other - Last Name:KHORSAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3020 CHILDREN'S WAY
Mailing Address - Street 2:RADY CHILDREN'S HOSPITAL
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1234
Mailing Address - Country:US
Mailing Address - Phone:858-966-8036
Mailing Address - Fax:
Practice Address - Street 1:3020 CHILDREN'S WAY
Practice Address - Street 2:RADY CHILDREN'S HOSPITAL
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1234
Practice Address - Country:US
Practice Address - Phone:858-268-0702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49591208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF49777Medicare UPIN