Kornblum, Harley Ian
Kornblum, Harley Ian is an individual health care provider with primary practice located at 10833 Le Conte Ave 12-441 Mdcc, Los Angeles CA 90095-3075. He recently has only one registered license in Allopathic & Osteopathic Physicians / Neurodevelopmental Disabilities, which is considered as his primary health care specialty. Kornblum, Harley Ian can be contacted via phone (310) 206-3952.Contact Information
Primary practice address
10833 Le Conte Ave 12-441 Mdcc
Los Angeles CA 90095-3075
Phone: (310) 206-3952
Fax: (310) 206-0209
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Neurodevelopmental Disabilities | 2080P0008X | G70261 | California |
Profile Details
| NPI number | 1386651115 |
|---|---|
| LBN Legal business name | Kornblum, Harley Ian |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 2nd, 2006 |
| Last updated | Jun 20th, 2012 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1386651115 | NPPES |
| California | MEDICAID | 00G702610 | |
| California | MEDICAID | GR0053510 |
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