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General NPI Number Information
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NPI Number | 1184808602
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Entity Type | Organization
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Legal Business Name | VADIM SKORUPKO DDS A PROFESSIONAL CORP
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Dates
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Enumeration Date | 12/19/2007
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Last Update Date | 06/10/2014
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Provider Practice Location Address
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Address Line | 490 POST ST STE 1528
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City | SAN FRANCISCO
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State | CA
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Zip | 94102-1311
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Country | US
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Telephone | 415-992-5160
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Fax |
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Provider Business Mailing Address
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Address Line | 490 POST ST STE 1528
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City | SAN FRANCISCO
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State | CA
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Zip | 94102-1311
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Country | US
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Telephone | 415-992-5160
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DASHA POLYAK
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Credential |
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Telephone | 408-266-1117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 41216
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License Number State | CA
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