Provider Demographics
NPI:1730568791
Name:KORAYEM, AHMED
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:
Last Name:KORAYEM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18500 VIA PRINCESSA STE 3
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91387-8325
Mailing Address - Country:US
Mailing Address - Phone:818-268-3355
Mailing Address - Fax:
Practice Address - Street 1:18500 VIA PRINCESSA STE 3
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91387-8325
Practice Address - Country:US
Practice Address - Phone:818-268-3355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-23
Last Update Date:2015-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC32392111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor