NPIMap

Individual provider Active NPI

Matthew Joshua King-Lung Kor, MD

  • Family Medicine Physician
  • San Andreas, CA
National Provider Identifier
1508329947
Registry record updated Sep 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A180770 Issued in CA
Practice address
702 Mountain Ranch Rd
San Andreas, CA 95249
Phone
(092) 754-4564
Fax
(209) 942-3462
NPI assigned
Apr 11, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 23, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X A180770 CA Primary

Addresses

Primary practice location

702 Mountain Ranch Rd
San Andreas, CA 95249

Mailing address

768 Mountain Ranch Rd
C/O Medical Staff Office
San Andreas, CA 95249-9707

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221027001075 CA Practitioner - Family Practice 4284067901 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sutter Lakeside Home Medical ServicesGroup PAC ID 1850338054, 19 clinicians
Sutter Bay HospitalsGroup PAC ID 3476506528, 45 clinicians

Practice addresses (Care Compare)

5176 Hill Rd E
OB GYN
Lakeport, CA 95453-6300

987 Parallel Dr
Suite C
Lakeport, CA 95453-5708
Phone (707) 262-5088

Hospital & facility affiliations

  • Sutter Care at Home Home health agency, Lakeport, CA, CCN 057620
  • Adventist Health Home Care Services Home health agency, Lower Lake, CA, CCN 057710
  • Sutter Lakeside Hospital Hospital, Lakeport, CA, CCN 051329
  • Adventist Health Clearlake Hospital, Clearlake, CA, CCN 051317
  • California Pacific Medical Ctr-Davies Campus Hosp Hospital, San Francisco, CA, CCN 050008

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A180770CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mark Twain Medical Center Single Specialty CurrentSince Aug 4, 2022 Accepting new patients
Sutter Bay Hospitals Single Specialty CurrentSince Nov 18, 2024 Accepting new patients
Sutter Bay Hospitals CurrentSince Nov 18, 2024 Accepting new patients

Locations

987 Parallel Dr
Ste C
Lakeport, CA 95453
Phone (707) 262-5000

5176 Hill Rd E
Lakeport, CA 95453
Phone (707) 262-5000

768 Mountain Ranch Rd
Ofc
San Andreas, CA 95249

768 Mountain Ranch Rd
San Andreas, CA 95249
Phone (209) 464-6422

702 Mountain Ranch Rd
San Andreas, CA 95249
Phone (209) 754-0870

Interoperability endpoints

  • Direct secure messaging: mkor704853@hisp.ehr.sutterhealth.org

Organizations & group practices 24

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 24

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1554940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663891200000",
    "number": "1508329947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "768 MOUNTAIN RANCH RD",
            "address_2": "C/O MEDICAL STAFF OFFICE",
            "city": "SAN ANDREAS",
            "state": "CA",
            "postal_code": "952499707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 MOUNTAIN RANCH RD",
            "city": "SAN ANDREAS",
            "state": "CA",
            "postal_code": "95249",
            "telephone_number": "092-754-4564",
            "fax_number": "209-942-3462"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOR",
        "first_name": "MATTHEW",
        "middle_name": "JOSHUA KING-LUNG",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-04-11",
        "last_updated": "2022-09-23",
        "certification_date": "2022-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A180770",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Andreas, CA

Sources for this page

Verify at the official NPI Registry.