Provider Demographics
NPI:1710049655
Name:BORIS ZHALKOVSKY MEDICAL CORPORATION
Entity Type:Organization
Organization Name:BORIS ZHALKOVSKY MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHALKOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-690-1155
Mailing Address - Street 1:20081 LAKE CHABOT ROAD
Mailing Address - Street 2:BORIS ZHALKOVSKY MEDICAL CORPORATION
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5303
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:BORIS ZHALKOVSKY MEDICAL CORPORATION
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5303
Practice Address - Country:US
Practice Address - Phone:510-690-1155
Practice Address - Fax:510-690-1344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A563750Medicaid
CA00A563750Medicaid