Healthcare Provider Details

I. General information

NPI: 1801044961
Provider Name (Legal Business Name): KONSTANTIN DAMIANOV BUKOV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 09/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2299 POST ST SUITE 303
SAN FRANCISCO CA
94115-3441
US

IV. Provider business mailing address

2299 POST STREET SUITE 303
SAN FRANCISCO CA
94115
US

V. Phone/Fax

Practice location:
  • Phone: 415-440-6800
  • Fax:
Mailing address:
  • Phone: 415-440-6800
  • Fax: 415-970-5023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036121911
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number53145-020
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA116876
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: