MEDICARE: USA VASCULAR CENTERS OF KENT PLLC

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	:	1356722938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	USA VASCULAR CENTERS OF KENT PLLC

Provider Business Mailing Address
First Line	:	4141 DUNDEE RD
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-2129
Country	:	US
Telephone Number	:	847-257-1244
Fax Number	:	224-246-8042

Provider Business Practice Location Address
First Line	:	26124A PACIFIC HWY S STE A
Second Line	:
City	:	KENT
State	:	WA
Zip	:	98032-6910
Country	:	US
Telephone Number	:	206-508-8768
Fax Number	:	224-235-4652

Authorized Official
Title or Position	:	DIRECTOR
Name	:	YAN KATSNELSON
Credential	:	MD
Telephone Number	:	847-257-1244

Provider Enumeration Date	:	06/09/2015
Last Update Date	:	05/12/2020

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