Provider Demographics
NPI:1972548741
Name:NOVIKOV, VIKTOR (MD)
Entity Type:Individual
Prefix:
First Name:VIKTOR
Middle Name:
Last Name:NOVIKOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:27212 CALAROGA AVE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-4339
Mailing Address - Country:US
Mailing Address - Phone:510-785-5000
Mailing Address - Fax:510-784-2502
Practice Address - Street 1:319 DIABLO RD
Practice Address - Street 2:STE 105
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-3428
Practice Address - Country:US
Practice Address - Phone:925-314-0260
Practice Address - Fax:925-831-2564
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA88497207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI48567Medicare UPIN