HARLEY IAN KORNBLUM M.D. NPI 1386651115

NPI Information

NPI: 1386651115
Provider Name: HARLEY IAN KORNBLUM, M.D.
Classification: Pediatrics - 2080P0008X
Entity Type: Individual

Specialization: Neurodevelopmental Disabilities

PECOS Registration: Yes

Address:
10833 LE CONTE AVE
12-441 MDCC
LOS ANGELES, CA
ZIP 90095
Phone: (310) 206-3952
Get Directions

Harley Ian Kornblum, M.D. is a neurodevelopmental disabilities pediatrics in Los Angeles, CA with 35 years of experience. The provider is a pediatrician who specializes in the treatment of individuals with developmental delays and learning disorders associated with cerebral palsy, spina bifida, autism, and other chronic neurologic conditions. Harley Ian Kornblum, M.D. NPI is 1386651115. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIVERSITY OF CALIFORNIA, IRVINE, CALIFORNIA COLLEGE OF MEDICINE
Graduation Year:1989

The provider's business location address is:

10833 LE CONTE AVE
12-441 MDCC
LOS ANGELES, CA
ZIP 90095-075
Phone: (310) 206-3952
Fax: (310) 206-0209

The NPI 1386651115 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 8/2/2006 and was last updated on 6/20/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2080P0008X	Pediatrics	Neurodevelopmental Disabilities	G70261	CALIFORNIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	W11810	MEDICARE ID-TYPE UNSPECIFIED	CALIFORNIA	GROUP NUMBER
2	00G702610	MEDICAID	CALIFORNIA
3	GR0053510	MEDICAID	CALIFORNIA
4	WG70261A	MEDICARE ID-TYPE UNSPECIFIED	CALIFORNIA
5	GC059Z	MEDICARE PIN	CALIFORNIA
6	F86534	MEDICARE UPIN	CALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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