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General NPI Number Information
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NPI Number | 1437563855
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Entity Type | Individual
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Provider Name | MARK DOUGLAS ZUKUNFT M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/13/2014
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Last Update Date | 12/16/2021
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Provider Practice Location Address
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Address Line | 250 HOSPITAL PKWY DEPT OF
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City | SAN JOSE
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State | CA
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Zip | 95119-1103
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Country | US
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Telephone | 408-972-6175
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Fax | 408-972-7794
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Provider Business Mailing Address
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Address Line | 250 HOSPITAL PKWY DEPT OF
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City | SAN JOSE
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State | CA
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Zip | 95119-1103
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Country | US
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Telephone | 408-972-6175
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Fax | 408-972-7794
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 125064693
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | A149737
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License Number State | CA
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