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1972171379

NPI Code Detail

MEDICARE: ELLYN M KORNFEIND MD

MEDICARE: ELLYN M KORNFEIND MD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207L00000X	Anesthesiology Physician	MD223927	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A198402	OTHER	CA	STATE MEDICAL BOARD
2	MD223927	OTHER	OR	STATE MEDICAL BOARD

General Provider Information

NPI Number	:	1972171379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLYN M KORNFEIND MD

Provider Business Mailing Address
First Line	:	908 NW 15TH ST
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97703-2126
Country	:	US
Telephone Number	:	610-761-9743
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 NE NEFF RD
Second Line	:
City	:	BEND
State	:	OR
Zip	:	97701-6015
Country	:	US
Telephone Number	:	250-097-7018
Fax Number	:

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

Provider Enumeration Date	:	06/14/2021
Last Update Date	:	07/18/2025

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Directions to “ ELLYN M KORNFEIND MD” Practice Location

Language	Start Address	Practice Location

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