Provider Demographics
NPI:1528792959
Name:KORCHIN, PETER L (CO)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:L
Last Name:KORCHIN
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18817 TOMAHAWK ST
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6236
Mailing Address - Country:US
Mailing Address - Phone:714-747-9446
Mailing Address - Fax:
Practice Address - Street 1:2933 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1517
Practice Address - Country:US
Practice Address - Phone:562-988-2414
Practice Address - Fax:562-490-2831
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO001475222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist