Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 00204187 | CO |
NPI | 1003439266 |
---|---|
Provider Name | Tetyana Korchynskyy |
First Address | Colorado Springs, CO 80906-4050 |
Second Address | Colorado Springs, CO 80906-4050 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2020 |
Last Update Date | 22/05/2020 |