Provider Demographics
NPI:1255403556
Name:KORNFELD, HERBERT R (MD)
Entity type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:R
Last Name:KORNFELD
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 1:2080 CENTURY PARK E
Mailing Address - Street 2:SUITE 1207
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2001
Mailing Address - Country:US
Mailing Address - Phone:310-553-2122
Mailing Address - Fax:310-286-1911
Practice Address - Street 1:2080 CENTURY PARK E
Practice Address - Street 2:SUITE 1207
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2001
Practice Address - Country:US
Practice Address - Phone:310-553-2122
Practice Address - Fax:310-286-1911
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG10040174400000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G100400Medicaid
95-3080303OtherEIN
CACQ223ZMedicare PIN
95-3080303OtherEIN
CA00G100400Medicaid
CAA37822Medicare UPIN
CACQ223YMedicare PIN