Healthcare Provider Details

I. General information

NPI: 1942551726
Provider Name (Legal Business Name): LING ZHU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2012
Last Update Date: 09/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11635 EAST SOUTH STREET
ARTESIA CA
90701
US

IV. Provider business mailing address

PO BOX 615
MONTEREY PARK CA
91754-0615
US

V. Phone/Fax

Practice location:
  • Phone: 562-924-4401
  • Fax:
Mailing address:
  • Phone: 626-203-2419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number61844
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: