Healthcare Provider Details

I. General information

NPI: 1699175851
Provider Name (Legal Business Name): VAL A SKORUPKO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: VADIM SKORUPKO

II. Dates (important events)

Enumeration Date: 08/25/2014
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 POST ST STE 1528
SAN FRANCISCO CA
94102-1311
US

IV. Provider business mailing address

490 POST ST STE 1528
SAN FRANCISCO CA
94102-1311
US

V. Phone/Fax

Practice location:
  • Phone: 415-992-5160
  • Fax:
Mailing address:
  • Phone: 415-992-5160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number41216
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: