Provider Demographics
NPI:1972952471
Name:KOR, CAROLYN LEI-TINA
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:LEI-TINA
Last Name:KOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 KAPAHULU AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-3850
Mailing Address - Country:US
Mailing Address - Phone:814-452-5105
Mailing Address - Fax:
Practice Address - Street 1:449 KAPAHULU AVE
Practice Address - Street 2:STE 104
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-3850
Practice Address - Country:US
Practice Address - Phone:814-452-5105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT211813207Q00000X
HIMD-21662207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine