MEDICARE: VADIM SKORUPKO DDS A PROFESSIONAL CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	41216	CA

General Provider Information

NPI Number	:	1184808602
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VADIM SKORUPKO DDS A PROFESSIONAL CORP

Provider Business Mailing Address
First Line	:	490 POST ST STE 1528
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94102-1311
Country	:	US
Telephone Number	:	415-992-5160
Fax Number	:

Provider Business Practice Location Address
First Line	:	490 POST ST STE 1528
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94102-1311
Country	:	US
Telephone Number	:	415-992-5160
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	DASHA POLYAK
Credential	:
Telephone Number	:	408-266-1117

Provider Enumeration Date	:	12/19/2007
Last Update Date	:	06/10/2014

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