Healthcare Provider Details

I. General information

NPI: 1033640537
Provider Name (Legal Business Name): TIAN HAO ZHU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2017
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20400 LAKE CHABOT RD STE 202
CASTRO VALLEY CA
94546-5315
US

IV. Provider business mailing address

1221 LEE ST MAILBOX 800718
CHARLOTTESVILLE VA
22908-0001
US

V. Phone/Fax

Practice location:
  • Phone: 510-881-7822
  • Fax: 510-881-8552
Mailing address:
  • Phone: 434-924-5115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA165460
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: