Healthcare Provider Details

I. General information

NPI: 1720111511
Provider Name (Legal Business Name): SHANGYOU ZHONG OMD, LAC, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 02/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9001 WILSHIRE BLVD STE 308
BEVERLY HILLS CA
90211-1841
US

IV. Provider business mailing address

9001 WILSHIRE BLVD STE 308
BEVERLY HILLS CA
90211-1841
US

V. Phone/Fax

Practice location:
  • Phone: 310-275-8887
  • Fax: 310-205-0628
Mailing address:
  • Phone: 310-275-8887
  • Fax: 310-205-0628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number3991
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: