MEDICARE: MR. JEFFREY I KORCHEK M.D

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	174400000X	Specialist	G50547	CA

General Provider Information

NPI Number	:	1669402228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY I KORCHEK M.D

Provider Business Mailing Address
First Line	:	10749 RIVERSIDE DR
Second Line	:
City	:	N HOLLYWOOD
State	:	CA
Zip	:	91602-2324
Country	:	US
Telephone Number	:	818-762-1740
Fax Number	:

Provider Business Practice Location Address
First Line	:	10749 RIVERSIDE DR
Second Line	:
City	:	N HOLLYWOOD
State	:	CA
Zip	:	91602-2324
Country	:	US
Telephone Number	:	818-506-0999
Fax Number	:

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

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	07/09/2007

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