Healthcare Provider Details

I. General information

NPI: 1821029042
Provider Name (Legal Business Name): ALEXANDER KORCHMAREV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 06/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13245 RIVERSIDE DR STE 507
SHERMAN OAKS CA
91423-5625
US

IV. Provider business mailing address

4227 SEPULVEDA BLVD
SHERMAN OAKS CA
91403
US

V. Phone/Fax

Practice location:
  • Phone: 818-788-7580
  • Fax: 818-788-7540
Mailing address:
  • Phone: 818-501-8978
  • Fax: 818-906-8804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA66569
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA66569
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: