Provider Demographics
NPI:1528281953
Name:GOLDKORN, AMIR (MD)
Entity type:Individual
Prefix:DR
First Name:AMIR
Middle Name:
Last Name:GOLDKORN
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:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-865-3105
Mailing Address - Fax:
Practice Address - Street 1:1441 EASTLAKE AVE
Practice Address - Street 2:NOR 8302E
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-0112
Practice Address - Country:US
Practice Address - Phone:323-865-3105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71867207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0016910OtherGROUP MEDICAID PIN
CAW11675OtherGROUP MEDICARE PIN
CA00A643210197OtherCAL OPTIMA
CA1356390009OtherGROUP NPI
CAP00322106OtherRAILROAD MEDICARE
CA1902846306OtherGROUP NPI
CA00A643210OtherBLUE SHIELD
CA06E2774OtherGROUP CHAMPUS
CACE1617OtherGROUP RAILROAD MEDICARE
CAZZZ50018ZOtherGROUP BLUE SHIELD
CA00A718670Medicaid
CAW18762OtherGROUP MEDICARE
CAGR0100430OtherGROUP MEDICAL
CACE1617OtherGROUP RAILROAD MEDICARE
CA1356390009OtherGROUP NPI