Healthcare Provider Details

I. General information

NPI: 1285560029
Provider Name (Legal Business Name): ZACHARY KALKANIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 GRAND AVE
OAKLAND CA
94610-5054
US

IV. Provider business mailing address

PO BOX 64204
LOS ANGELES CA
90064-0204
US

V. Phone/Fax

Practice location:
  • Phone: 415-474-7310
  • Fax: 510-257-1821
Mailing address:
  • Phone: 510-640-4001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW135539
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: