Healthcare Provider Details

I. General information

NPI: 1497589113
Provider Name (Legal Business Name): SUSANNA ZHU DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2024
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14415 CULVER DR
IRVINE CA
92604-0305
US

IV. Provider business mailing address

50 CORAL REEF
NEWPORT COAST CA
92657-1904
US

V. Phone/Fax

Practice location:
  • Phone: 951-500-7818
  • Fax:
Mailing address:
  • Phone: 951-500-7818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number110596
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: