MEDICARE: HUNTINGTON PARK VEIN CLINIC PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician

General Provider Information

NPI Number	:	1316346778
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUNTINGTON PARK VEIN CLINIC PC

Provider Business Mailing Address
First Line	:	2822 E FLORENCE AVE
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-5749
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2822 E FLORENCE AVE
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-5749
Country	:	US
Telephone Number	:	847-305-3346
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	YAN KATSNELSON
Credential	:	MD
Telephone Number	:	847-305-3346

Provider Enumeration Date	:	08/21/2014
Last Update Date	:	08/21/2014

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