NPIMap

Organization Active NPI

Longlife Medical Inc.

  • Point of Service
  • Mesa, AZ
National Provider Identifier
1497975684
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Point of ServiceTaxonomy code 305S00000X
License
3393 Issued in AZ
Legal business name
LONGLIFE MEDICAL INC.
Practice address
6632 E. Baseline Rd.
Ste. 103
Mesa, AZ 85206-4428
Phone
(480) 354-6700
Fax
(480) 354-6708
NPI assigned
Apr 27, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. David C Korn, D.D.S.,D.O.
Title
Medical Director
Phone
(480) 354-6700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Point of Service 305S00000X 3393 AZ Primary

Addresses

Primary practice location

6632 E. Baseline Rd.
Ste. 103
Mesa, AZ 85206-4428

Mailing address

6632 E. Baseline Rd.
Ste. 103
Mesa, AZ 85206-4428
Phone (480) 354-6700

National Provider Directory

National Provider Directory

Locations

11518 E Apache Trl
Ste 115
Apache Junction, AZ 85120
Phone (480) 354-6700

6632 E Baseline Rd
Ste 103
Mesa, AZ 85206
Phone (480) 354-6700

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1497975684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6632 E. BASELINE RD.",
            "address_2": "STE. 103",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852064428",
            "telephone_number": "480-354-6700",
            "fax_number": "480-354-6708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6632 E. BASELINE RD.",
            "address_2": "STE. 103",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852064428",
            "telephone_number": "480-354-6700",
            "fax_number": "480-354-6708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGLIFE MEDICAL INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KORN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "480-354-6700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S.,D.O."
    },
    "taxonomies": [
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "AZ",
            "license": "3393",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.