Active NPI
Kenneth Leslie Corum Jr.
- Pharmacist
- Wildomar, CA
National Provider Identifier
1629324181
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 65205
- Practice address
- 36010 Hidden Springs Rd
Wildomar, CA 92595-7622 - Phone
- (951) 678-1755
- Fax
- (951) 678-7677
- NPI assigned
- Aug 1, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 65205 | CA | Primary |
Addresses
Primary practice location
36010 Hidden Springs Rd
Wildomar, CA 92595-7622
Mailing address
36010 Hidden Springs Rd
Wildomar, CA 92595-7622
Phone (951) 678-1755
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1343779200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1343779200000",
"number": "1629324181",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "36010 HIDDEN SPRINGS RD",
"city": "WILDOMAR",
"state": "CA",
"postal_code": "925957622",
"telephone_number": "951-678-1755",
"fax_number": "951-678-7677"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "36010 HIDDEN SPRINGS RD",
"city": "WILDOMAR",
"state": "CA",
"postal_code": "925957622",
"telephone_number": "951-678-1755",
"fax_number": "951-678-7677"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORUM",
"first_name": "KENNETH",
"middle_name": "LESLIE",
"name_suffix": "Jr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-08-01",
"last_updated": "2012-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "65205",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wildomar, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.