Provider Demographics
NPI:1134304348
Name:CORBOY, KERRY JO (MD)
Entity type:Individual
Prefix:MS
First Name:KERRY
Middle Name:JO
Last Name:CORBOY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 E ADAMS PARK DR
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-2926
Mailing Address - Country:US
Mailing Address - Phone:626-331-6988
Mailing Address - Fax:
Practice Address - Street 1:1441 EAST ADAMS PARK DRIVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-2926
Practice Address - Country:US
Practice Address - Phone:626-331-6988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67240207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H79191Medicare UPIN