Provider Demographics
NPI:1669400388
Name:ZEME, MARK (M D)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:ZEME
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20400 LAKE CHABOT RD STE 301
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5316
Mailing Address - Country:US
Mailing Address - Phone:510-889-6673
Mailing Address - Fax:510-889-0913
Practice Address - Street 1:20400 LAKE CHABOT RD STE 301
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5316
Practice Address - Country:US
Practice Address - Phone:510-889-6673
Practice Address - Fax:510-889-0913
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66448207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G664480Medicaid
CA040008496OtherRAILROAD MEDICARE NUMBER
CA00G664480Medicare PIN
CA00G664480Medicaid