Provider Demographics
NPI:1518146489
Name:ZHALKOVSKY, BORIS (MD)
Entity Type:Individual
Prefix:DR
First Name:BORIS
Middle Name:
Last Name:ZHALKOVSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20081 LAKE CHABOT ROAD
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94564-5303
Mailing Address - Country:US
Mailing Address - Phone:510-690-1155
Mailing Address - Fax:510-690-1344
Practice Address - Street 1:20081 LAKE CHABOT ROAD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94564-5303
Practice Address - Country:US
Practice Address - Phone:510-690-1155
Practice Address - Fax:510-690-1344
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA563752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A563750Medicaid
CA00A563750Medicaid
CA00A563750Medicare PIN