| Doctor Name: | JACOB J KORNBERG |
| NPI Number: | 1457394025 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | MD00015354 |
| Business Practice Address: | 33838 Pacific Hwy S Suite B-200 Federal Way, WA - 980036891 |
| Business Phone Number: | 2538351540 |
| Business Fax Number: | 2538351546 |
| Mailing Address: | 33838 Pacific Hwy S, Suite B-200 FEDERAL WAY |
| State: | WA |
| Postal Code: | 980036891 |
| Phone Number: | 2538351540 |
| Fax Number: | 2538351546 |
| NPI Enumeration Date: | 06/13/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | MD00015354 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |