Healthcare Provider Details

I. General information

NPI: 1427953587
Provider Name (Legal Business Name): YIDAN ZHU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8086 ORANGE AVE
FAIR OAKS CA
95628-5941
US

IV. Provider business mailing address

6049 WANDERING STAR DR
ROSEVILLE CA
95747-8465
US

V. Phone/Fax

Practice location:
  • Phone: 916-534-7226
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number757945
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: