Provider Demographics
NPI:1922041052
Name:KORN, ERROL RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:ERROL
Middle Name:RICHARD
Last Name:KORN
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 1:1044 PACIFIC HILL ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6831
Mailing Address - Country:US
Mailing Address - Phone:619-425-5544
Mailing Address - Fax:619-421-3838
Practice Address - Street 1:769 MEDICAL CENTER CT # 303
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6602
Practice Address - Country:US
Practice Address - Phone:619-425-5544
Practice Address - Fax:619-421-3838
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG15481207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G154810Medicaid
CAAZ031XMedicare PIN
CAA90388Medicare UPIN
CA00G154810Medicaid