Provider Demographics
NPI:1720228273
Name:USA VEIN CLINIC INC
Entity Type:Organization
Organization Name:USA VEIN CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FLORA
Authorized Official - Middle Name:
Authorized Official - Last Name:KATSNELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-877-8752
Mailing Address - Street 1:PO BOX 832
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60065-0832
Mailing Address - Country:US
Mailing Address - Phone:888-768-3467
Mailing Address - Fax:262-877-2632
Practice Address - Street 1:7901 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 209
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-5177
Practice Address - Country:US
Practice Address - Phone:888-768-3467
Practice Address - Fax:262-877-2632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1062542086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA106254OtherMEDICAL LICENSE