Provider Demographics
NPI:1851308035
Name:KORCHINSKI, JEAN A (MD)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:A
Last Name:KORCHINSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3307 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-1909
Mailing Address - Country:US
Mailing Address - Phone:503-359-4469
Mailing Address - Fax:503-357-4882
Practice Address - Street 1:3307 19TH AVE
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116-1909
Practice Address - Country:US
Practice Address - Phone:503-359-4469
Practice Address - Fax:503-357-4882
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD11788207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR002589000OtherREGENCE BCBS
OR227405Medicaid
OR002589000OtherREGENCE BCBS
ORC93077Medicare UPIN