Healthcare Provider Details

I. General information

NPI: 1003428673
Provider Name (Legal Business Name): GEREMY ZHANG DNP, PHMNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 W 7TH ST STE 1200
LOS ANGELES CA
90017-3423
US

IV. Provider business mailing address

811 W 7TH ST STE 1200
LOS ANGELES CA
90017-3423
US

V. Phone/Fax

Practice location:
  • Phone: 310-430-7324
  • Fax: 310-430-7324
Mailing address:
  • Phone: 310-430-7324
  • Fax: 310-430-7324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95025349
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number832693
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: