| Korie Medical Corporation Dba Soul Klinic | |
|
25050 Peachland Ave Ste 170 Santa Clarita CA 91321-2523 | |
| (661) 506-0607 | |
| Not Available |
| Full Name | Korie Medical Corporation Dba Soul Klinic |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 25050 Peachland Ave Ste 170, Santa Clarita, California |
| Authorized Official Name and Position | Ijendu Korie (OWNER) |
| Authorized Official Contact | 6615060607 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Korie Medical Corporation Dba Soul Klinic 25050 Peachland Ave Ste 170 Santa Clarita CA 91321-2523 Ph: (661) 506-0607 | Korie Medical Corporation Dba Soul Klinic 25050 Peachland Ave Ste 170 Santa Clarita CA 91321-2523 Ph: (661) 506-0607 |
| NPI Number | 1992457162 |
|---|---|
| Provider Enumeration Date | 01/19/2022 |
| Last Update Date | 11/11/2022 |
| Certification Date | 11/11/2022 |
| Medicare PECOS PAC ID | 8820482870 |
|---|---|
| Medicare Enrollment ID | O20220308001947 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992457162 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Ijendu Peace Korie |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1568826410 PECOS PAC ID: 2668710815 Enrollment ID: I20220316000121 |
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