NPI Code Detail JSON Logo

1609036771 NPI number — INNA V VELYCHKO M.D.

NPI Number: 1609036771
Health Care Provider/Practitioner: INNA V VELYCHKO M.D.

Information about “1609036771” NPI (INNA V VELYCHKO M.D.) exists in 1609036771 in HTML format HTML  |  1609036771 in plain Text format TXT  |  1609036771 in PDF (Portable Document Format) PDF  |  1609036771 in an XML format XML  formats.

NPI Number : 1609036771 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1609036771",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "VELYCHKO",
    "FirstName": "INNA",
    "MiddleName": "V",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 226",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BRUSH PRAIRIE",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98606-0226",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "503-387-7111",
    "MailingAddressFaxNumber": "971-288-1045",
    "FirstLinePracticeLocationAddress": "9300 SE 91ST AVE STE 201",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PORTLAND",
    "PracticeLocationAddressStateName": "OR",
    "PracticeLocationAddressPostalCode": "97086-3762",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "503-387-7111",
    "PracticeLocationAddressFaxNumber": "503-567-7706",
    "EnumerationDate": "06/12/2008",
    "LastUpdateDate": "11/13/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "57.012943",
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "MD183825",
          "LicenseNumberStateCode": "OR",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "MD60155804",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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