Provider Demographics
NPI:1578270575
Name:KOCHANSKI, JOHN JOSEPH IV
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JOSEPH
Last Name:KOCHANSKI
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 EXCHANGE ST STE 111
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-3366
Mailing Address - Country:US
Mailing Address - Phone:503-325-0333
Mailing Address - Fax:
Practice Address - Street 1:2120 EXCHANGE ST STE 111
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3366
Practice Address - Country:US
Practice Address - Phone:503-325-0333
Practice Address - Fax:503-325-6333
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
ORPA213842363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant