Basic Information
| Provider Information | |||||||||
| NPI: | 1639286495 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KORE | ||||||||
| FirstName: | ARPUTHARAJ | ||||||||
| MiddleName: | HIGGINS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 670 | ||||||||
| Address2: | |||||||||
| City: | REDLANDS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9097773397 | ||||||||
| FaxNumber: | 9097773395 | ||||||||
| Practice Location | |||||||||
| Address1: | 197 EAST CAROLINE STREET | ||||||||
| Address2: | SUITE 1400 | ||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924083729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095583636 | ||||||||
| FaxNumber: | 9095583722 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2006 | ||||||||
| LastUpdateDate: | 09/25/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 00AS18240 | CA | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0129X | 00AS18240 | CA | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 204F00000X | 00AS18240 | CA | Y | Allopathic & Osteopathic Physicians | Transplant Surgery |
ID Information
| ID | Type | State | Issuer | Description | GR0079700 | 05 | CA | MEDICAID |