Healthcare Provider Details

I. General information

NPI: 1548241417
Provider Name (Legal Business Name): ZICHANG PAN DDS & SHUYUN ZENG DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39560 STEVENSON PL SUITE 220
FREMONT CA
94539-3074
US

IV. Provider business mailing address

39560 STEVENSON PL SUITE 220
FREMONT CA
94539-3074
US

V. Phone/Fax

Practice location:
  • Phone: 510-818-0182
  • Fax: 510-818-0313
Mailing address:
  • Phone: 510-818-0182
  • Fax: 510-818-0313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number46417
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number46717
License Number StateCA

VIII. Authorized Official

Name: MS. SHUYUN ZENG
Title or Position: PRESIDENT
Credential: DDS
Phone: 510-818-0182