Provider Demographics
NPI:1720280027
Name:KORNGOLD, EFREM (OMD, LAC)
Entity type:Individual
Prefix:
First Name:EFREM
Middle Name:
Last Name:KORNGOLD
Suffix:
Gender:M
Credentials:OMD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 NOE ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-3713
Mailing Address - Country:US
Mailing Address - Phone:415-285-0931
Mailing Address - Fax:415-285-0968
Practice Address - Street 1:1201 NOE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-3713
Practice Address - Country:US
Practice Address - Phone:415-285-0931
Practice Address - Fax:415-285-0968
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 208171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist