Provider Demographics
NPI:1679555304
Name:KORORI, KAMROOZ (DDS)
Entity type:Individual
Prefix:
First Name:KAMROOZ
Middle Name:
Last Name:KORORI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8709 92ND ST
Mailing Address - Street 2:FLOOR 2
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-2102
Mailing Address - Country:US
Mailing Address - Phone:718-805-3600
Mailing Address - Fax:718-805-4200
Practice Address - Street 1:8709 92ND ST
Practice Address - Street 2:FLOOR 2
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-2102
Practice Address - Country:US
Practice Address - Phone:718-805-3600
Practice Address - Fax:718-805-4200
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049137122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02159740Medicaid