Provider Demographics
NPI:1558633859
Name:VLADIMIR KAYE, M.D., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:VLADIMIR KAYE, M.D., A PROFESSIONAL CORPORATION
Other - Org Name:H&W MANAGEMENT, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VLADIMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:KAYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-278-9744
Mailing Address - Street 1:3123 BERMUDA DR
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-2303
Mailing Address - Country:US
Mailing Address - Phone:949-278-9744
Mailing Address - Fax:310-400-3059
Practice Address - Street 1:159 N RAYMOND AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-4609
Practice Address - Country:US
Practice Address - Phone:949-278-9744
Practice Address - Fax:310-400-3059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA642442081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA64244Medicare PIN