Healthcare Provider Details

I. General information

NPI: 1548444631
Provider Name (Legal Business Name): ANDY YONGDE ZHU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 W COVELL BLVD
DAVIS CA
95616-5658
US

IV. Provider business mailing address

3400 DATA DR
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 530-668-2600
  • Fax: 530-756-5817
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA104156
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: