Healthcare Provider Details

I. General information

NPI: 1356355499
Provider Name (Legal Business Name): KEN ZUCKERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 52ND ST DEPT OF ANESTHESIOLOGY
OAKLAND CA
94609-1809
US

IV. Provider business mailing address

4916 OVERTON PLZ
FORT WORTH TX
76109-4415
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-3070
  • Fax: 510-450-5853
Mailing address:
  • Phone: 800-585-0868
  • Fax: 817-334-0235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA49619
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: