Healthcare Provider Details

I. General information

NPI: 1336670611
Provider Name (Legal Business Name): HAIRAN ZHU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 11/29/2021
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3875 AVOCADO BLVD
LA MESA CA
91941-7303
US

IV. Provider business mailing address

3875 AVOCADO BLVD
LA MESA CA
91941-7303
US

V. Phone/Fax

Practice location:
  • Phone: 619-851-0992
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA157525
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: