Provider Demographics
NPI:1619630381
Name:VLADIMIR SKOROKHOD MD CORPORATION
Entity Type:Organization
Organization Name:VLADIMIR SKOROKHOD MD CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VLADIMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:SKOROKHOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-867-6104
Mailing Address - Street 1:5912 MOUNTAIN MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95135-1655
Mailing Address - Country:US
Mailing Address - Phone:559-827-6130
Mailing Address - Fax:
Practice Address - Street 1:5912 MOUNTAIN MEADOW CT
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95135-1655
Practice Address - Country:US
Practice Address - Phone:559-827-6130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service