Healthcare Provider Details

I. General information

NPI: 1437252301
Provider Name (Legal Business Name): VLADIMIR G. SKOROKHOD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 BLOSSOM HILL RD SUITE 49
SAN JOSE CA
95118-3806
US

IV. Provider business mailing address

1375 BLOSSOM HILL RD SUITE 49
SAN JOSE CA
95118-3806
US

V. Phone/Fax

Practice location:
  • Phone: 408-440-8335
  • Fax: 408-440-2762
Mailing address:
  • Phone: 408-440-8335
  • Fax: 408-440-2762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number39530
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA98375
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: