Healthcare Provider Details

I. General information

NPI: 1558633859
Provider Name (Legal Business Name): VLADIMIR KAYE, M.D., A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2012
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 N RAYMOND AVE
FULLERTON CA
92831-4609
US

IV. Provider business mailing address

3123 BERMUDA DR
COSTA MESA CA
92626-2303
US

V. Phone/Fax

Practice location:
  • Phone: 949-278-9744
  • Fax: 310-400-3059
Mailing address:
  • Phone: 949-278-9744
  • Fax: 310-400-3059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA64244
License Number StateCA

VIII. Authorized Official

Name: VLADIMIR KAYE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 949-278-9744