MEDICARE: WANSHENG ZHU DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	100622	CA
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	36103	TX
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1073968806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WANSHENG ZHU DDS

Provider Business Mailing Address
First Line	:	8631 E HERMOSA DR
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91775-3006
Country	:	US
Telephone Number	:	626-808-2756
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 N STATE ST
Second Line	:	CLINIC TOWER, SUITE A7D
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-1029
Country	:	US
Telephone Number	:	626-808-2756
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2016
Last Update Date	:	05/12/2020

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