Healthcare Provider Details

I. General information

NPI: 1275541419
Provider Name (Legal Business Name): TATYANA ZHUKOVSKY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 LA PLAYA ST
SAN FRANCISCO CA
94121-3262
US

IV. Provider business mailing address

760 LA PLAYA ST
SAN FRANCISCO CA
94121-3262
US

V. Phone/Fax

Practice location:
  • Phone: 415-221-5592
  • Fax: 415-221-8826
Mailing address:
  • Phone: 415-221-5592
  • Fax: 415-221-8826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number43274
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: