Healthcare Provider Details

I. General information

NPI: 1114575081
Provider Name (Legal Business Name): KAI COSMO ZAJAC PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2019
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 X ST
SACRAMENTO CA
95817-2214
US

IV. Provider business mailing address

4301 X ST
SACRAMENTO CA
95817-2214
US

V. Phone/Fax

Practice location:
  • Phone: 800-282-3284
  • Fax:
Mailing address:
  • Phone: 831-239-9489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA57323
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: