Provider Demographics
NPI:1437252301
Name:SKOROKHOD, VLADIMIR G (MD)
Entity Type:Individual
Prefix:MR
First Name:VLADIMIR
Middle Name:G
Last Name:SKOROKHOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 BLOSSOM HILL RD
Mailing Address - Street 2:SUITE 49
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118-3806
Mailing Address - Country:US
Mailing Address - Phone:408-440-8335
Mailing Address - Fax:408-440-2762
Practice Address - Street 1:1375 BLOSSOM HILL RD
Practice Address - Street 2:SUITE 49
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95118-3806
Practice Address - Country:US
Practice Address - Phone:408-440-8335
Practice Address - Fax:408-440-2762
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39530207P00000X
CAA98375207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A983750Medicaid
CAA98375OtherBLUE CROSS
CA00A983750OtherBLUE SHIELD
CA00A983750Medicare PIN
CA00A983750OtherBLUE SHIELD
CA161956Medicare UPIN
CA00A983750Medicare Oscar/Certification