Healthcare Provider Details

I. General information

NPI: 1154482289
Provider Name (Legal Business Name): QIANRU ZHU D.D.S., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13768 ROSWELL AVE SUITE 116
CHINO CA
91710-1401
US

IV. Provider business mailing address

2376 RIDGEVIEW AVE
ROWLAND HEIGHTS CA
91748-4862
US

V. Phone/Fax

Practice location:
  • Phone: 909-627-1266
  • Fax: 909-627-3228
Mailing address:
  • Phone: 626-581-8988
  • Fax: 909-627-3228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number53117
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: