MEDICARE: PETER L. KORCHIN CO

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	222Z00000X	Orthotist	CO001475

General Provider Information

NPI Number	:	1528792959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER L. KORCHIN CO

Provider Business Mailing Address
First Line	:	18817 TOMAHAWK ST
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-6236
Country	:	US
Telephone Number	:	714-747-9446
Fax Number	:

Provider Business Practice Location Address
First Line	:	2933 LONG BEACH BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-1517
Country	:	US
Telephone Number	:	562-988-2414
Fax Number	:	562-490-2831

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

Provider Enumeration Date	:	07/12/2022
Last Update Date	:	07/12/2022

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Directions to “ PETER L. KORCHIN CO” Practice Location

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