Provider Demographics
NPI:1932271780
Name:ZAHAROFF, KONSTANTIN G JR (MD)
Entity type:Individual
Prefix:
First Name:KONSTANTIN
Middle Name:G
Last Name:ZAHAROFF
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KON
Other - Middle Name:
Other - Last Name:ZAHAROFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MPH
Mailing Address - Street 1:1800 HARRISON ST FL 7
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3429
Mailing Address - Country:US
Mailing Address - Phone:510-625-6262
Mailing Address - Fax:
Practice Address - Street 1:401 BICENTENNIAL WAY
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2149
Practice Address - Country:US
Practice Address - Phone:707-571-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG577492083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G577490Medicaid
F10899Medicare UPIN
CA00G577490Medicaid