Healthcare Provider Details

I. General information

NPI: 1053390203
Provider Name (Legal Business Name): VICTOR Y KOPYEV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2006
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1949 STATE ROUTE 59 STE 102
KENT OH
44240-8124
US

IV. Provider business mailing address

1949 STATE ROUTE 59 STE 102
KENT OH
44240-8124
US

V. Phone/Fax

Practice location:
  • Phone: 330-673-0505
  • Fax: 330-673-8708
Mailing address:
  • Phone: 330-673-0505
  • Fax: 330-673-8708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number35.074815
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35074815
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: