Healthcare Provider Details

I. General information

NPI: 1043618366
Provider Name (Legal Business Name): JING ZHAI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2014
Last Update Date: 10/11/2021
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 MARTIN LUTHER KING JR AVE
LONG BEACH CA
90813-3616
US

IV. Provider business mailing address

1090 MARTIN LUTHER KING JR AVE
LONG BEACH CA
90813-3616
US

V. Phone/Fax

Practice location:
  • Phone: 310-266-0244
  • Fax:
Mailing address:
  • Phone: 310-266-0244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number235707
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: