Provider Demographics
NPI:1568536951
Name:KOROLEV, VLADIMIR N (LAC, LMT)
Entity Type:Individual
Prefix:MR
First Name:VLADIMIR
Middle Name:N
Last Name:KOROLEV
Suffix:
Gender:M
Credentials:LAC, LMT
Other - Prefix:MR
Other - First Name:VOLODYA
Other - Middle Name:
Other - Last Name:KOROLEV
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC, LMT
Mailing Address - Street 1:PO BOX 1777
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-1777
Mailing Address - Country:US
Mailing Address - Phone:808-391-3086
Mailing Address - Fax:
Practice Address - Street 1:803 KAMEHAMEHA HWY
Practice Address - Street 2:SUITE 416
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782
Practice Address - Country:US
Practice Address - Phone:808-391-3086
Practice Address - Fax:808-486-3416
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI643171100000X
HI5111225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist