Healthcare Provider Details

I. General information

NPI: 1780741090
Provider Name (Legal Business Name): DA ZHEN TRAVEL AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17331 E VALLEY BLVD
LA PUENTE CA
91744-5653
US

IV. Provider business mailing address

17331 E VALLEY BLVD
LA PUENTE CA
91744-5653
US

V. Phone/Fax

Practice location:
  • Phone: 626-581-1113
  • Fax: 626-934-7986
Mailing address:
  • Phone: 626-581-1113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number060000836
License Number StateCA

VIII. Authorized Official

Name: XUEYUE SONG
Title or Position: CEO
Credential:
Phone: 626-877-6287