Provider Demographics
NPI:1619689270
Name:KORIN, ANGELINA V
Entity Type:Individual
Prefix:
First Name:ANGELINA
Middle Name:V
Last Name:KORIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9853 SE 134TH AVE
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-5959
Mailing Address - Country:US
Mailing Address - Phone:360-955-1567
Mailing Address - Fax:
Practice Address - Street 1:8317 NE 157TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-1702
Practice Address - Country:US
Practice Address - Phone:360-955-1567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home