Healthcare Provider Details

I. General information

NPI: 1497165781
Provider Name (Legal Business Name): JUNLI ZHA MD PHD CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2014
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4980 BARRANCA PKWY STE 110
IRVINE CA
92604-8654
US

IV. Provider business mailing address

4980 BARRANCA PKWY STE 110
IRVINE CA
92604-8654
US

V. Phone/Fax

Practice location:
  • Phone: 949-262-0838
  • Fax: 949-656-7081
Mailing address:
  • Phone: 949-262-0838
  • Fax: 949-656-7081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA76073
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberANTI-AGING
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberA76073
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberA76073
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberA76073
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberA760730
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License NumberA76073
License Number StateCA

VIII. Authorized Official

Name: DR. JUNLI ZHA
Title or Position: PRINCIPLE MEDICAL DIRECTOR
Credential: MD, PHD
Phone: 949-262-0838