Healthcare Provider Details

I. General information

NPI: 1316574452
Provider Name (Legal Business Name): CONSTANTINE KULKOFF D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date: 07/29/2025
Reactivation Date: 09/19/2025

III. Provider practice location address

1393 SANTA RITA RD STE F
PLEASANTON CA
94566-5667
US

IV. Provider business mailing address

1393 SANTA RITA RD STE F
PLEASANTON CA
94566-5667
US

V. Phone/Fax

Practice location:
  • Phone: 415-580-1342
  • Fax:
Mailing address:
  • Phone: 415-580-1342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number20A19557
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number20A19557
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: