# JEREMY E. KORMAN MD, A PROFESSIONAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** JEREMY E. KORMAN MD, A PROFESSIONAL CORPORATION
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1255609004
- **Legal business name:** JEREMY E. KORMAN MD, A PROFESSIONAL CORPORATION
- **Authorized official:** DR. JEREMY KORMAN M.D. (PRESIDENT)
- **Authorized official phone:** (310) 577-5540

## Contact information

- **Practice address:** 4644 LINCOLN BLVD, SUITE 450, MARINA DEL REY, CA 90292-6313
- **Practice address phone:** (310) 577-5540
- **Mailing address:** 2980 N BEVERLY GLEN CIR, SUITE 301, LOS ANGELES, CA 90077-1726
- **Mailing address phone:** (310) 474-9809

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | — | NULL | Yes |

## Other

- **Enumeration date:** 12/08/2011
- **Last updated:** 12/08/2011