MEDICARE: BRIAN JOCHIM DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DE60446726	WA
2	122300000X	Dentist	D9994	OR
3	390200000X	Student in an Organized Health Care Education/Training Program
4	1223P0221X	Pediatric Dentistry	DE60446726	WA

General Provider Information

NPI Number	:	1245518059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN JOCHIM DMD

Provider Business Mailing Address
First Line	:	8400 NE VANCOUVER MALL LOOP STE 105
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98662-6672
Country	:	US
Telephone Number	:	360-219-9616
Fax Number	:

Provider Business Practice Location Address
First Line	:	1440 N LOMBARD ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-5533
Country	:	US
Telephone Number	:	971-242-4355
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2011
Last Update Date	:	04/19/2018

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