Provider Demographics
NPI:1669402228
Name:KORCHEK, JEFFREY I (MD)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:I
Last Name:KORCHEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10749 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:N HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2324
Mailing Address - Country:US
Mailing Address - Phone:818-762-1740
Mailing Address - Fax:
Practice Address - Street 1:10749 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:N HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91602-2324
Practice Address - Country:US
Practice Address - Phone:818-506-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50547174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA92983Medicare UPIN