Healthcare Provider Details

I. General information

NPI: 1760579130
Provider Name (Legal Business Name): CHU ZHANG DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 W MANCHESTER AVE
LOS ANGELES CA
90047-5422
US

IV. Provider business mailing address

2233 W MAIN ST #B
ALHAMBRA CA
91801-1775
US

V. Phone/Fax

Practice location:
  • Phone: 323-753-1141
  • Fax:
Mailing address:
  • Phone: 626-320-4608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number54545
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: