Provider Demographics
NPI:1366459075
Name:ZAKHARYAN, SERGEI V (MD)
Entity type:Individual
Prefix:DR
First Name:SERGEI
Middle Name:V
Last Name:ZAKHARYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 E SHAW AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710
Mailing Address - Country:US
Mailing Address - Phone:559-224-0106
Mailing Address - Fax:559-224-1968
Practice Address - Street 1:1095 E SHAW AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710
Practice Address - Country:US
Practice Address - Phone:559-224-0106
Practice Address - Fax:559-224-1968
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55925208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A559250Medicaid
G24382Medicare UPIN
CA00A559250Medicaid