Provider Demographics
NPI:1972171379
Name:KORNFEIND, ELLYN M (MD)
Entity Type:Individual
Prefix:
First Name:ELLYN
Middle Name:M
Last Name:KORNFEIND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELLIE
Other - Middle Name:
Other - Last Name:KORNFEIND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:25041 FERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3418
Mailing Address - Country:US
Mailing Address - Phone:610-761-9743
Mailing Address - Fax:
Practice Address - Street 1:11234 ANDERSON ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2804
Practice Address - Country:US
Practice Address - Phone:909-558-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program