Provider Demographics
NPI:1982702130
Name:KORNFELD, HOWARD GORDON (MD)
Entity type:Individual
Prefix:MR
First Name:HOWARD
Middle Name:GORDON
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 1:38 MILLER AVE #503
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941
Mailing Address - Country:US
Mailing Address - Phone:415-383-2949
Mailing Address - Fax:415-383-6887
Practice Address - Street 1:3 MADRONA ST
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94944
Practice Address - Country:US
Practice Address - Phone:415-383-2949
Practice Address - Fax:415-383-6887
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG034976208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A46168Medicare UPIN