Healthcare Provider Details

I. General information

NPI: 1295371532
Provider Name (Legal Business Name): JEFFREY ALLEN ZHAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2019
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 TERMINO AVE STE 108
LONG BEACH CA
90804-2126
US

IV. Provider business mailing address

1703 TERMINO AVE STE 108
LONG BEACH CA
90804-2126
US

V. Phone/Fax

Practice location:
  • Phone: 562-498-2481
  • Fax: 562-494-6651
Mailing address:
  • Phone: 562-498-2481
  • Fax: 562-494-6651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number61001118
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA61001118
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2317
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA61633
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: