Provider Demographics
NPI:1912952276
Name:CORBEN, DARRELL (MD)
Entity Type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:
Last Name:CORBEN
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:PO BOX 464
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94042-0464
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:441 DEGUIGNE DR
Practice Address - Street 2:#1
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085-3875
Practice Address - Country:US
Practice Address - Phone:877-845-8959
Practice Address - Fax:877-845-8959
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA052058207RS0010X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG18131Medicare UPIN
CA00A520580Medicare ID - Type Unspecified