Healthcare Provider Details

I. General information

NPI: 1356722938
Provider Name (Legal Business Name): USA VASCULAR CENTERS OF KENT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2015
Last Update Date: 05/12/2020
Certification Date: 05/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26124A PACIFIC HWY S STE A
KENT WA
98032-6910
US

IV. Provider business mailing address

4141 DUNDEE RD
NORTHBROOK IL
60062-2129
US

V. Phone/Fax

Practice location:
  • Phone: 206-508-8768
  • Fax: 224-235-4652
Mailing address:
  • Phone: 847-257-1244
  • Fax: 224-246-8042

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: 847-257-1244