Basic Information
| Provider Information | |||||||||
| NPI: | 1588634513 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KORSAND | ||||||||
| FirstName: | SID | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KHORSAND | ||||||||
| OtherFirstName: | SAEID | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3020 CHILDREN'S WAY | ||||||||
| Address2: | RADY CHILDREN'S HOSPITAL | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921231234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8589668036 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3020 CHILDREN'S WAY | ||||||||
| Address2: | RADY CHILDREN'S HOSPITAL | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921231234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8582680702 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2006 | ||||||||
| LastUpdateDate: | 12/02/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | A49591 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.