Healthcare Provider Details

I. General information

NPI: 1710359211
Provider Name (Legal Business Name): USA VEIN CLINICS OF DISTRICT OF COLUMBIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2015
Last Update Date: 12/30/2020
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6323 GEORGIA AVE NW
WASHINGTON DC
20011-1101
US

IV. Provider business mailing address

304 WAINWRIGHT DR
NORTHBROOK IL
60062-1900
US

V. Phone/Fax

Practice location:
  • Phone: 847-257-1244
  • Fax: 224-246-8042
Mailing address:
  • Phone: 847-593-8460
  • Fax: 224-246-8460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: YAN KATSNELSON
Title or Position: DIRECTOR
Credential: MD
Phone: 847-593-8460