Healthcare Provider Details

I. General information

NPI: 1245658988
Provider Name (Legal Business Name): GLENDALE VEIN CLINIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S CHEVY CHASE DR
GLENDALE CA
91205-4431
US

IV. Provider business mailing address

PO BOX 832
NORTHBROOK IL
60065-0832
US

V. Phone/Fax

Practice location:
  • Phone: 323-798-1800
  • Fax:
Mailing address:
  • Phone: 847-593-8460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberA106254
License Number StateCA

VIII. Authorized Official

Name: FLORA KATSNELSON
Title or Position: MANAGER
Credential: MD
Phone: 847-305-8460