Healthcare Provider Details

I. General information

NPI: 1326176140
Provider Name (Legal Business Name): ALYOSHA ZIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3031 TELEGRAPH AVE #143
BERKELEY CA
94705-2051
US

IV. Provider business mailing address

3031 TELEGRAPH AVE #143
BERKELEY CA
94705-2051
US

V. Phone/Fax

Practice location:
  • Phone: 510-549-2866
  • Fax: 510-527-9513
Mailing address:
  • Phone: 510-549-2866
  • Fax: 510-527-9513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG22729
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: